Double Pivot Local Flap-a New Way For Closure of Resilient Tracheocutaneous Fistula

A persistent tracheocutaneous fistula is a common complication of tracheostomy stoma closure, when the primary purpose of the tracheostomy has been solved. It is basically a squamous epithelium-lined tract connecting the skin to the stoma of the trachea, which forms as a sequelae of long-term tracheostomy and prevents spontaneous closure of the tract. The usual or the commonest method for this closure involves primary suturing of the stoma. But if it fails, flap closure becomes the necessity. In this article, we describe the method of closure of a persistent tracheocutaneous fistula using local random rotation skin flaps. In places where major myocutaneous flap closure is difficult to perform because of the patient's health or unavailability of proper setup, this technique becomes useful. Hence, it reduces the cost of surgery, can be done using local anesthesia, is a shorter procedure, and reduces the strain of surgery on the patient