Conventional versus Flap Tracheostomy: Operative Simplicity, Stomal Care, Complications

Abstract

Introduction
 Tracheostomy is a life saving procedure and its operative principle has withstood the test of time although the operative techniques have evolved. Inferiorly based flap on the anterior tracheal wall (Bjork flap) was demonstrated in 1952. The present study aims to compare conventional tracheostomy with flap tracheostomy.
 Materials and Methods
 A Randomized Control Trial was conducted in a tertiary care teaching medical institute comparing conventionally tracheostomised patients (Group A) with the group where flap based method was followed (Group B).
 Results
 The study population was comprised of 110 patients with equitable distribution in the groups. Per-operative time to establish an airway was measured and statistically correlated. 9.26% patients of Group A had difficult tube change, with none in Group B. Ease of stomal care by the patient and family members (Visual Analogue Scale), depicted it to be “very easy” in 76.36% of the patients in Group B and 16.36% in Group A. Stomal healing in first week was proper in 61.82% of patients in Group A and 80% of the patients in Group B. Tracheo-cutaneous fistula (TCF) developed in 18.18% of the adult and geriatric patients of Group A undergoing stomal closure. None of the patients in Group B had TCF following stomal closure.
 Conclusion
 Establishing Bjork flap tracheostomy is equally quick making the process suited for emergency situations. Flap based tracheostomy has early stomal maturation so, care of the stoma by health assistants and family members is easy.

A Comparative Analysis of Conventional Tracheotomy Versus Bjork Flap Tracheotomy

“…The mean VAS scores of patients operated through conventional tracheotomy were significantly higher (p≤0.05) for other varied parameters at all procedural steps on the second and seventh day in comparison to the Bjork flap group, suggesting that Bjork flap tracheotomy has an edge over the conventional tracheotomy. Similar findings have been reported earlier [ 15 ]. The study illustrated that tube change was difficult in conventional tracheotomy patients and required the intervention and support of an ENT surgeon to the nursing staff.…”

“…The intergroup variation regarding the demographic profile (mean age and gender) of patients between the groups showed no statistical difference (p≤0.05). Similar results have been reported in another study that compared conventionally tracheotomized patients with those in whom a flap-based method was followed [15].…”

“…Hence, it is safer to employ Bjork flap tracheotomy as it helps in providing a tracheal conduit bridge that directs the tracheostomy tube and prevents erroneous passage. Also, early maturity of the stoma is ensured by the flap-based treatment with improved mucosalization of the tract [ 15 ].…”

Tracheostomie/Tracheotomie

“…Der Zugang zur Trachea erfolgte als Exzision der 3. und 4. Trachealknorpelringe [9]. Aufgrund geringerer Infektionsraten und zur Erleichterung der Kanülenwechsel sollte sich eine Epithelialisierung, also das Schaffen einer direkt abschließenden tracheokutanen Einnaht mit Einzelknopfnähten, anschließen.…”

Tracheostomy-related indications, early complications and their predictors among patients in low resource settings: a prospective cohort study in the pre-COVID-19 era

“…The Bjork flap is an inferiorly based tracheal flap through the 2 nd , 3 rd , and 4 th tracheal rings which is fixed to the skin to stabilize the tracheal lumen. Although it has a risk for tracheal stenosis, it has advantages over traditional incisional and excisional window procedures including; reduced risk of false cannulation especially during emergency recannulation following accidental tube dislodgement, early stomal maturation and ease of stomal care by assistants and family members [29][30][31]. These make it the preferred tracheal incision in our setting for patients who require tracheostomy for longer durations such as those with head and neck tumors.…”