From 1974 through 1984, 23 patients with combined tracheoesophageal injuries from penetrating wounds were treated. Physical examination, endoscopy, a barium swallow, or a combination of these techniques confirmed the diagnosis preoperatively in 19 patients. A variety of operative techniques were used, with 20 of 23 repairs involving some type of primary repair of the trachea and esophagus, such as side repair or end-to-end anastomosis, with or without a tracheostomy. Major complications occurred in 74 percent of the patients and included eight cases of pneumonia, eight esophageal leaks, six tracheoesophageal fistulas, five mediastinal abscesses, four wound infections, and two carotid artery blowouts. To decrease the number of complications, several refinements in operative technique have been suggested.