Closure of large tracheocutaneous fistula: how we did it

Persistent tracheocutaneous fistulas are common and often needs surgical repair for closure. However large fistulas are uncommon given that majority of patients undergoing tracheostomy have no pre-existing lesions or deformity on the trachea. We present the case of a 61-year-old female with a successful closure of a persistent large tracheocutaneous tissue defect that resulted from poor healing due to primary thyroid diffuse large B cell lymphoma which is a rare type of extranodal lymphoma. The strap muscles were removed during the debulking surgery to obtain tissue diagnosis as well as to relieve upper airway obstruction. Tracheostomy was also performed in the same setting. Combined with the plastic reconstructive team, we repaired the tracheal defect by using bilateral sternocleidomastoid muscle flap interpositioned between the tracheal wall and the subcutaneous closure, without using any tracheal stents. Post-operative recovery was uneventful and during subsequent follow-up no recurrent fistula formation or deformity seen. This is a simple and effective method for treating large tracheocutaneous fistulas.