A case of tracheal rupture after a Lewis-Tanner esophagectomy in a patient with carcinoma of the esophagus was complicated by the formation of a tracheoesophageal fistula after initial direct repair. The fistula was successfully treated with a pectoralis major muscle flap moved into the superior mediastinum by a sternotomy and excision of the upper part of the sternum and adjacent costal cartilages.