Closure of irradiated tracheocutaneous fistula with pectoralis major muscle flap and split skin graft

Abstract

Tracheocutaneous fistula in an irradiated neck is often difficult to manage. Simple closure often leads to dehiscence and recurrence. We present a patient with supraglottic carcinoma, postradiotherapy, who presented with a persistent trachea-cutaneous fistula. We excised the fistula along with surrounding indurated tissue and covered the defect adequately with skin graft for tracheal lining and pectoralis muscle flap as a muscle cover. Fistula was closed and wound healed well. There was no recurrence of fistula as evidenced with indirect laryngoscopy. Pectoralis major flap is a well-vascularized flap that can be used to cover defects in anterior lower neck. Simple skin graft with a cover of muscle flap was enough to give adequate tracheal lining.