Tracheo-esophageal fistulae caused by prolonged intubation can be life-threatening to the patient involved. Older techniques for the closure of these fistulae were generally unsafe in infected tissues, were replete with complications, and had to be done in multiple stages. We describe a single-stage procedure for closure of posterior tracheal wall defects. A partially deepithelialized cervical flap is rotated between the sutured esophagus and the trachea. This reconstructed posterior wall is resistent to the presence of a cannula. In order to prevent recurrence of the fistula (if further respiratory treatment is needed), a small nasogastric tube or a long Penrose drain placed in the esophagus should serve as feeding tubes.