The patient is a 52 year old female who underwent pharyngo-laryn-gectomy and transhiatal total esophagectomy with gastric pull-up for a cancer of the cervical esophagus nine years ago. She com-plained of sudden cough, and was subsequently diagnosed with a fistula between the gastric tube and the membranous portion of the treachea in the posterior mediastinum. Transthoracic fistula closure by a latissimus dorsi musculocutaneous flap, during which vascular pedicle was introduced through the right second intercostal space was carried out successfully.