Bipedicle delayed flap closure of persistent radiated tracheocutaneous fistulas

Increasing numbers of patients have had tracheostomies for prolonged periods of time and when subsequently decannulated have developed persistent tracheocutaneous fistula. A substantial percentage of these patients have undergone successful combined modality therapy excluding surgery for advanced head and neck cancer with resulting healing deficits of the remaining tissues. Although these patients may be deemed suitable for decannulation at this particular point, the potential still exists that access to the trachea will be required sometime in the future. This situation requires a method of closure that is reasonably reliable and yet, at the same time, relatively easily reversible. The surgical technique presented appears to meet these demands. After primary inversion of the edges of the tracheocutaneous fistula, a bipedicle flap is developed and positioned over the tracheostomy site. The inferior edge of the flap is left open for temporary air escape to decompress the suture line. This line subsequently heals by secondary intention over the succeeding weeks. Although there has not been, to date, the need to reverse the closure, the relative thinness of the tissue as opposed to alternative techniques suggests that it should not be difficult.