Tracheotomy in Children

Closure of persistent tracheocutaneous fistula following “starplasty” tracheostomy in children

“…Some authors argue that primary closure is associated with an unacceptable complication rate, opting instead for closure by secondary intention [3,8,10,12]. Other authors cite low complication rates, improved cosmetic results and the ability to observe the patient in the hospital following immediate closure [2,7,13,14,16].…”

“…The rate of persistent TCF in children following standard tracheotomy is between 3 and 43%, greatest when tracheotomy is performed in infancy and also increasing with the length of cannulation. [2,3] The ''starplasty'' tracheostomy, introduced in 1990, is an alternative pediatric tracheostomy technique in which a TCF is intentionally created by constructing a continuous circumferential mucocutaneous suture line between the cervical skin and tracheal mucosa [4]. The rationale for this procedure was to reduce the risk of perioperative pneumothorax and accidental tube displacement as well as to hasten stomal maturation.…”

Primary closure of persistent tracheocutaneous fistula in pediatric patients

“…The fistula persists in 3.3% [1] to 43% [2] of patients. However, extending the duration of cannulation can significantly increase the risk of developing a persistent fistula [3].…”

Closure of tracheocutaneous fistula in children

“…Tracheocutaneous fistula (TCF) has been reported to occur in 3.3-52% of pediatric patients following tracheostomy decannulation [1][2][3]. Problems associated with TCF include respiratory infections from recurrent aspiration, skin irritation and hygiene issues, and difficulties with swimming.…”