PRIMARY CLOSURE OF PERSISTENT TRACHEOCUTANEOUS FISTULA IN CHILDREN

Thirty-six patients with persistent tracheocutaneous fistula (TCF) aft er pediatric tracheotomy were managed at Children's Memorial Hospital in Chicago between June 1987 and July 1992. Persistent TCF was managed with surgical excision and primary closure. The mean patient age was 5 years 7 months, and the mean duration between decannulation and fist ula closure was 21 months. There were no major complications and four minor complications. While most surgeons advocate other techniques, we feel that excision with primary closure is the preferred method for p ersistent TCF. The technique requires an airtight tracheal closure wit h loose closure of the peristomal soft tissue. Careful preoperative ev aluation, postoperative monitoring, and wound drainage are stressed.