Turnover flap closure of recalcitrant tracheostomy fistula: a simplified approach.

Abstract

Chronic and nonclosing tracheostomy fistula can often significantly impair quality of life, vocalization, and local hygiene. Although many of these fistulas close on their own after decannulation or after local debridement, a significant percentage do not and require flap closure. In this article, the authors present their experience with a multilayered flap closure technique that has proven reliable, quick, and extremely easy to perform, even in recalcitrant cases. A medially based turnover skin flap closes the tracheal defect without tension and does not narrow the lumen. Double and layered local muscular coverage provides healthy soft-tissue coverage and eliminates a tethered and depressed scar appearance. Skin closure respects relaxed tension lines. Six patients with recalcitrant tracheostomy fistula have to date undergone this repair without recurrence, and cosmesis has been excellent. Complicated and recurrent tracheal fistulas are successfully treated with a tension-free, multilayered flap reconstruction; the design incorporates fundamental aesthetic and reconstructive principles.