Tracheocutaneous Fistula

What is a tracheocutaneous fistula (TCF)?

A tracheocutaneous fistula (tra-kee-o-ee-sof- a-jee-al fis-tu-la) is a hole in the neck that connects to the wind pipe (trachea) directly to the skin. This happens when a child’s tracheostomy incision does not close by itself after the tracheostomy tube has been removed.

Why did my child’s surgeon recommend closure of the fistula?

Your surgeon may recommend closure of the fistula for a number of reasons including:

• aspiration of foreign material,
• recurrent lower respiratory tract infections,
• difficulties with producing speech and sound,
• ineffective cough,
• skin irritation,
• overall appearance, or
• inability to safely take a bath or swim.

How is the surgery performed?

TCF closure is performed by an ear, nose, and throat surgeon. Your surgeon may simply remove the skin inside the fistula and let it heal over the next 2 to 3 weeks. Or your surgeon may suture the hole closed after removing the skin inside the fistula. Your surgeon may inspect the inside of the wind pipe with a surgical camera before performing the skin removal.

This procedure is performed in the operating room under general anesthesia. Your child will be carefully monitored before, during, and after the procedure. Anesthesia is very safe and routinely used.  You will have a chance to talk with the anesthesiologist the day of surgery to discuss any questions you may have.

Are there any instructions I need to follow before surgery?

• Your child must have a physical examination by his or her provider within 30 days before surgery to make sure he or she is in good health. The doctor you see needs to complete the History and Physical form provided by our office. You must bring the completed form with you the day of surgery.
• For your child's safety, it is very important that he or she have an empty stomach when anesthesia is given. Please follow Children’s Hospitals’ Eating and Drinking Guidelines as provided to you. If you do not follow these guidelines, your child's surgery will be cancelled.
• If your ENT provider has requested that you take or stop medications prior to surgery, please follow their instruction.

What can I expect after surgery?

• The procedure itself usually takes no more than 90 minutes. Your child will wake up in the recovery room and be transitioned to a hospital room for overnight observation.
• This overnight observation is used to make sure your child’s airway and breathing is okay after surgery. If there are no problems overnight, your child will be able to leave the hospital in the morning.
• A small drain may have been placed during the procedure. The drain will be removed by a member of the surgical team before your child goes home.
• Your doctor may prescribe Tylenol®(acetaminophen) or Children's Motrin®(ibuprofen) for any short term discomfort. You will receive instructions on how much medicine to give and how often.
• Fevers up to 102.0 F are considered normal after surgery. Call your provider for fevers over 102.0F that do not come down with Tylenol® (acetaminophen) or Children's Motrin® (ibuprofen).
• Your surgeon may recommend a follow-up visit in the ENT clinic. Check with your nurse before you leave the hospital to see if you need to schedule this appointment.
• Your child may return to his or her regular diet as tolerated after surgery.
• Your child may return to normal activities except for swimming and submerging the neck under water. You should wait until your surgeon tells you it is safe for your child’s neck to go under water.

Questions?

The information provided in this brochure is not specific to your child. This information is provided as a service to our patients. The information is for educational and informational purposes only and should NOT be used as a substitute for the advice of your child’s physician. If you have any questions, please call your Ears, Nose, and Throat clinic.

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