title: Closure of a tracheocutaneous fistula by two hinged turnover skin flaps and a muscle flap: A case report.
abstract: BACKGROUND
  Tracheocutaneous fistula is a complication of tracheostomy. Tracheocutaneous fistulectomy followed by primary closure carries a high possibility of complications.
  
  
  METHODS
  An 11-year-old boy underwent surgery to repair a tracheocutaneous fistula, using skin and muscle flaps. A vertical incision was made around the fistula and 3 skin flaps were prepared: 2 hinge flaps, and 1 to cover the skin defect (advanced flap). The 2 hinged turnover flaps were invaginated by multiple layered sutures, and a strap muscle flap was placed over the resulting tracheal closure. An advanced skin flap was used to cover the area of the previous defect. The patient was extubated immediately after surgery. He was discharged on the sixth postoperative day without tracheal leakage or subcutaneous emphysema. The patient is currently doing well, with no respiratory symptoms and no recurrence at the postoperative 5 months.
  
  
  CONCLUSIONS
  Our technique is minimally invasive and has a low risk of lumen stenosis, other complications, or recurrence.
  
  
  CONCLUSIONS
  This technique demonstrates the multiple-layered closure of a tracheocutaneous fistula, using skin flaps and a muscle flap.
authors.affiliation: Department of Pediatric Surgery, National Hospital Organization, Fukuyama Medical Center, Japan. Electronic address: tatekawa3966@diary.ocn.ne.jp.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Tatekawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yamanaka
authors.forename: Toshimichi
authors.initials: T
authors.lastname: Hasegawa