To delineate a technique that avoids the complications associated with surgical closure of long-term or permanent tracheostomy (LTT). A case series that describes the technique and clinical outcomes. Thirty-seven of 300 patients with a previously established LTT underwent primary surgical closure of their stoma after their underlying disease had been resolved. The surgical technique combined a turnover flap with medialization of fibroadipose tissue, followed by additional closure with an advancement skin flap. After a mean follow-up of 3.2 years, no patient developed major complications. Four patients developed minor complications, which responded to conservative treatment. In all patients, the functional results were satisfactory, as were the cosmetic results, with the exception of 1 case. None required re-tracheostomy. This simple and reliable new surgical technique for closing LTT avoids the potential failures and complications encountered in previously published procedures.