Tracheocutaneous fistula (TCF) is one of the recognized sequelae of tracheotomy in the pediatric age group. Persistent TCF can cause considerable morbidity due to recurrent aspiration, and subsequent respiratory infection, difficulty in phonation, ineffective cough, skin irritation, cosmesis, social acceptance, and intolerance to submersion. Methods of TCF closure remain controversial and vary based on the otolaryngologist's preference. The authors' choice is fistulectomy with primary closure in layers as this definitively removes the fistula and provides the patient with a good cosmetic result without the need for any significant postoperative wound care. The following chapter describes our techniques as well as surgical pearls for success.
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