Complications of tracheotomy tube placement can be categorized as intraoperative, early postoperative, and late postoperative. Among the late complications is the development of granulation tissue. We describe one of the few reported cases of granulation tissue that formed within a fenestrated tracheotomy tube. In this case, the granulation tissue grew through the fenestrations, obliterated the tracheal lumen, and tethered the tube to the trachea itself. As a result, the patient required emergency treatment to restore airway patency.