Better functional and cosmetic results are achieved after the closure of an epithelialized tracheostomy if a method suited to the closure technique is selected when the stoma is first created. We choose a horizontal skin incision which also allows an incision running along the tension lines of the neck to be used when closing the tracheostomy. The flap from the anterior tracheal wall reported by Björk is of functional value and for closure of the stoma also. When the skin has been previously damaged, we suggest covering the defect in patients with tracheal fistulae by a bridge flap from the neck skin, avoiding the use of distant flaps which are cosmetically less favourable.
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