Management of Tracheocutaneous Fistula

Closure of tracheocutaneous fistula in children

“…Our current practice of 48 h of post-operative observation has been influenced by the potential for serious complications. Reports in the literature have raised awareness of outcomes such as subcutaneous emphysema, pneumothorax, pneumomediastinum and acute respiratory distress following a technique incorporating primary closure [4,5]. The results of our series, and other larger series that also had no subcutaneous emphysema or major respiratory complication [3,6] suggest that a shorter period of observation may be sufficient.…”

Massive subcutaneous emphysema after removal of tracheostomy cannula

“…Subcutaneous emphysema, however, can appear after primary closure of a permanent tracheostomy or after surgical closure of a tracheocutaneous fistula. [1][2][3][4] The probable mechanism for massive subcutaneous emphysema in our case was premature closure of the skin over the tracheostomy site by a relatively thin membrane of neo-epithelium and granulation tissue, without closure of the underlying trachea by granulation tissue.…”

Incidence of Persistent Tracheocutaneous Fistula After Pediatric Tracheostomy Decannulation

“…Another group also found that the duration of tracheostomy dependence was associated with the need for surgical TCF closure 9 . Mucocutaneous overgrowth followed by squamous epithelialization propagates the development of a TCF 17 . This results in epithelial migration into the tracheal mucosa 1,2 preventing cicatricial scarring that typically creates a closure 2 .…”

“…9 Mucocutaneous overgrowth followed by squamous epithelialization propagates the development of a TCF. 17 This results in epithelial migration into the tracheal mucosa 1,2 preventing cicatricial scarring that typically creates a closure. 2 As the trend continues towards more chronic indications for pediatric tracheostomy, 18 the anticipation is that a persistent TCF will be more likely to occur.…”