Closure of Paediatric Tracheocutaneous Fistula: Surgical Technique
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2025-03-03
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Open Access Atlas of Otolaryngology, Head & Neck Operative Surgery
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University of Cape Town
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Abstract
A tracheocutaneous fistula (TCF) is an epithelial-lined communication between skin and trachea that persists after decannulation (removal) of a tracheostomy tube. TCF rates are higher in paediatric patients. It is a recognised complication of long-standing tracheostomies and has been linked to long-er duration of tracheostomy dependence. Complications associated with a persistent TCF include skin irritation; inadequate glottic closure causing a weak cough and air-way compromise; poor phonation; poor cosmesis; increased risk of aspiration during swimming, bathing etc. Addressing a persistent TCF avoids delays with integration into society and mainstream schooling. TCF is due to squamous epithelialisation of the tracheostomy tract. Closure is achieved by excising the fistula followed either by primary closure or allowing for healing to occur by secondary intention. Although primary closure provides immediate resolution of the fistula and better cosmesis, it may be associated with life-threatening complications. Allowing healing by secondary intention minimises such potential complications. It may however be perceived as “inconvenient” for the patients.
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Hlomani, B. & Peer, S. 2025. Closure of Paediatric Tracheocutaneous Fistula: Surgical Technique. In Open Access Atlas of Otolaryngology, Head & Neck Operative Surgery. J. Fagan, Ed.Cape Town, South Africa: University of Cape Town. 7. http://hdl.handle.net/11427/43493 .