Acquired, traumatic tracheoesophageal fistula [TEF] is rare and difficult problem to manage. This 55 years old man met with a roller accident of a tractor. During accident, he received a penetrating injury on the left upper sternal border. At local clinic, he received closed thoracotomy drainage [CTD]for relief of pneumothorax[left]. Three days after CTD, he complained abdominal pain and hematemesis. The endoscopy revealed large ulcer at the stomach, so he received subtotal gastrectomy. On 10th day post subtotal gastrectomy, he developed aspiration and coughing from a TEF. The esophagogram showed large TEF at the mid-trachea level. So he transfered to our hospital for operation. This patient was operated on for late TEF three weeks after injury. We have used absorble 4-0 Vicryl sutures to repair trachea. We repair all esophageal injuries with two layers of nonabsorbable silk suture. Where suture line on the esophagus, the strap muscle was interposed for reinforcement. And for feeding, the feeding jejunostomy was performed. Postoperatively the osteomyelitis of the manubrium site was developed, so on the 30th postoperative day, an ostectomy of manubrium, both clavicle and fight 1st, 2nd ribs, and the pectoralis major musculo-cutaneous flap coverage were performed.