Tracheal Incision as a Contributing Factor to Tracheal Stenosis: An Experimental Study

Abstract

Tracheostomies were performed on 25 mongrel dogs, employing either a vertical or inverted U flap incision in the trachea. Following cannulation for 14 days, the animals were maintained for three months and endolarygeal photographs were taken. At the time of autopsy, comparisons of the gross specimens were carried out, as well as histological sectioning through the tracheal stomal area. Both endolaryngeal examination and study of the gross specimens at autopsy revealed less distortion of the tracheal lumen following the flap versus vertical tracheostomy, especially in those animals having the flap of cartilage resewn to the trachea at the time of decannulation. Measurements of the cross sectional area at the tracheal stoma were also made. In animals having a flap tracheostomy, the stomal lumen was preserved, regardless of resuturing the flap. However, animals having a vertical tracheostomy lost an average of 18% of the tracheal area when compared with those having a flap incision. Histological examination revealed cartilaginous growth across the tracheostomy incision only in animals having the flap tracheostomy. Support for the flap tracheostomy is provided from animal experimentation.

A single-center 6-year experience with two types of pediatric tracheostomy

“…In contrast to previous animal studies comparing different types of tracheal incision, which showed either that the vertical incision should be the incision of choice [18] or that the inferior flap tracheostomy should be favorized [17,20], it is our opinion that the type of tracheal incision is relatively insignificant concerning the occurrence of clinically relevant postoperative tracheal stenosis.…”

“…Vertical tracheal incision [17][18][19] and creation of inferiorly [17,18,20] or superiorly [19] based tracheal flaps in animal models have also been studied. The incidence of late complications related to the stoma or tracheal lesions such as tracheal stenosis, formation of granulation tissue, suprastomal collapse, or fatal complications could not clearly be related to the type of tracheal incision or the creation of a tracheal flap [21,22].…”

Tracheal collapse after thyroidectomy

“…The use of PVC tubes and low pressure 'floppy' cuffs has greatly diminished the risk of tracheal injury after prolonged intubation by either route (Cooper and Grillo, 1972;Crawley and Cross, 1975) and stenosis is most likely to occur at the site of the stoma after tracheostomy (Friman et al, 1976), particularly if this has been carelessly or incorrectly fashioned (Lulenski and Batsakis, 1975). In this situation, where the trachea is already abnormal and possibly distorted, endotracheal intubation, if possible, is to be preferred.…”

Permanent Tracheostomy for Long-Term Respiratory Studies

“…Several types of tracheostomy incisions in dogs, including transverse and vertical, U-shaped flap through two tracheal rings, and excision of 1 cm segments of 1 and 2 rings have been compared [5,6,8,16,17,22]. Vertical tracheostomy shows the most consistent healing [5,6].…”

“…However, tracheotomy and tracheal stoma intubation present noteworthy hazards and complications. Some of the more common complications include tracheal stenosis secondary to cuffed endotracheal tube inflation [2][3][4][20][21][22], pneumonia [10,14], tracheobronchitis [13,14], tracheitis [11], hemorrhage from innominate artery dissection [9,24], laryngeal trauma including laryngeal nerve damage [14], stoma occlusion [14], stoma closure [12][13][14], and tracheoesophageal fistula [23,24].…”