title: Tracheocutaneous fistula closure in the pediatric population: should secondary closure be the standard of care?
abstract: OBJECTIVE
  Tracheocutaneous fistula (TCF) closure is achieved by excision followed either by primary closure or healing by secondary intention. Although primary closure provides immediate resolution of the fistula, it is associated with more severe potential complications. Healing by secondary intention minimizes these potential complications; however, it is inconvenient for the patient and may be more likely to require revision surgery. We have had 2 life-threatening complications after primary closure, and as a result, we largely changed our practice pattern. We compared complication and success rates of the 2 methods since this change to determine its ramifications.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  Academic tertiary care pediatric otolaryngology practice. Subjects and Methods Two hundred sixteen patients who underwent TCF closure between January 2004 and August 2012.
  
  
  RESULTS
  Forty-six (21.3%) fistulae were addressed by primary closure, and 170 (78.7%) were addressed by secondary intention. The complication and revision rates were not significantly different between the 2 methods (8.7% vs 10% and 8.7% vs 14.7%, respectively).
  
  
  CONCLUSIONS
  In our study, we did not see any statistical differences between the 2 methods studied but could not exclude clinically important differences that may have favored one method over the other. Although our comparative results were inconclusive, we have adopted secondary closure as standard practice for management of pediatric TCF. Individual surgeons and patients may use the data presented to help guide decisions concerning which procedure is most appropriate.
authors: Division of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Alexander J
authors: AJ
authors: Osborn
authors: Alessandro
authors: A
authors: de Alarcón
authors: Catherine K
authors: CK
authors: Hart
authors: Robin T
authors: RT
authors: Cotton
authors: Michael J
authors: MJ
authors: Rutter
mesh_terms: D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D059039:Standard of Care; D014133:Tracheal Diseases / Q000209:etiology / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects; D016896:Treatment Outcome
keywords: airway complication; pediatric; tracheocutaneous fistula; tracheocutaneous fistula closure; tracheotomy