Tracheocutaneous Fistula Excision With Single, Deep-Layer Closure.

Tracheocutaneous fistula (TCF) can occur following pediatric tracheostomy decannulation. Traditional surgical options include primary layered closure and secondary intention healing, each with benefits and risks. We describe a hybrid technique combining tract excision with single deep-layer closure and secondary healing of superficial tissues, aiming to balance effective closure without risk of postoperative subcutaneous emphysema. A retrospective review from 2020 to 2025 identified 37 pediatric patients who underwent this procedure at our institution, with no cases of postoperative emphysema and no need for repeat fistula closure. Eleven patients (29.7%) later underwent scar revision for cosmetic improvement. Two illustrative cases are presented to demonstrate clinical outcomes and surgical detail. This hybrid approach has become the favored technique of two institutional otolaryngologists and offers a reproducible, safe, and effective alternative to traditional TCF closure methods.