ABSTRACT
Q1 The most serious complication of closure of a tracheocutaneous fistula is: A bleeding B wound infection C wound breakdown D scar E pneumothorax.
A1 E Tracheocutaneous fistula is a result of epithelialisation of the skin tract from the anterior neck to the trachea that fails to close following decannulation. While all answers are complications of tracheocutaneous fistula, pneumothorax following fistula closure can result in rapid airway compromise and death. Traditional primary closure, a multilayered technique, can result in air that extravasates from the trachea becoming trapped under the reapproximated cutaneous and deeper layers. This air can track into the chest, resulting in a pneumothorax or pneumomediastinum. Drain placement and observation may decrease this risk, as will the use of a secondary intention closure, in which the skin tract to the level of the trachea is excised and no dermal or epidermal closure is performed.
