Closure of Large Tracheocutaneous Fistula With Island Deltopectoral Flap

Tracheocutaneous fistula (TCF) formation is a complication of long-term tracheostomy use. Surgical closure is necessary for a persistent TCF because this can lead to various complications. Herein, we describe our use of an island deltopectoral (DP) flap to treat a large TCF. A 62-year-old male, who had previously undergone supraglottic partial laryngectomy with laser and radiation therapy, presented with a second recurrence of supraglottic cancer. Supracricoid partial laryngectomy and cricohyoidoepiglottopexy (CHEP) were performed. Afterward, a large TCF measuring about 2.0×2.5 cm developed. The island DP flap facilitated successful TCF closure. There have been no recurrences or complications, and both the reconstruction site and donor site are well-maintained after 25 months of follow-up. The island DP flap can be a useful option for large TCF closure, even for patients who have had previous radiation therapy.