Fistula formation between the trachea and the innominate artery following tracheostomy is a rare, but life-threatening complication. Because of its clinical presentation with acute, massive, intractable bleeding, the mortality is nearly 100% without operation. To the best of our knowledge, the autologous pericardium flap for coverage of the tracheal defect has not been discussed in the English-language literature. We successfully treated one case of tracheoinnominate artery fistula following tracheostomy by using autologous pericardium flap.