Abstract
Persistent tracheocutaneous fistula after decannulation is an annoying complication. The standard approach to it is the surgical suturing of the fistula. Because the direct closure of the fistula at the level of the tracheal wall sometimes causes tracheal stenosis, alternative procedures such as the hinged skin flap technique, cartilage interposition grafting or muscle flap technique have been reported. Herein, we report a new and simple method, the sternohyoid muscle flap technique, for the closure of persistent tracheocutaneous fistula. The patient was a 4-year-old boy with Pierre Robin syndrome, who underwent tracheostomy because of acquired membranous subglottic stenosis. He was decannulated after successful KTP and semiconductor laser therapies for the subglottic stenosis. However, the tracheocutaneous fistula did not spontaneously close; thus, regular tracheal wall closure was performed. After the closure of the fistula of 6 × 3 mm size, he suffered from respiratory distress due to tracheal stenosis. Thus, the fistula was reopened and closed using the right sternohyoid muscle flap sutured to the surrounding tracheal wall. The procedure was associated with dyspnea resolution, and the patient was discharged from the hospital five days after the operation. At the four-month follow-up, tracheal patency at the tracheostomy site was confirmed by computed tomography and ventilation bronchoscopy. The patient has been doing well since then with only mild respiratory distress after vigorous exercise, which is considered to be due to remaining subglottic membranous stenosis. When the direct closure of the tracheocutaneous fistula causes tracheal stenosis, the sternohyoid muscle flap technique is the treatment of choice.
