Management of Tracheocutaneous Fistula

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

“…A variety of TCF closure techniques have been advocated and can be classified as primary closure in layers [13], primary closure with fistulectomy [2,7,14,16] and fistulectomy with closure by secondary intent [8,10,12,15]. Some authors argue that primary closure is associated with an unacceptable complication rate, opting instead for closure by secondary intention [3,8,10,12].…”

“…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].…”

“…Not surprisingly, the primary drawback to the ''starplasty'' procedure is the high incidence of persistent TCF following decannulation. Persistent TCF in pediatric patients has been reported to result in difficulties with speech, swallowing, aspiration as well as social and hygiene problems [7,8]. Therefore, once the need for the tracheostomy has resolved, closure of the TCF is desirable.…”

“…While there are several accepted techniques for TCF closure, there is nevertheless controversy about the safest method due to the low but well recognized incidence of associated morbidity from pneumothorax, pneumomediastinum, tracheal stenosis and infection [7][8][9][10][11][12]. Given the unique design of the ''starplasty'' procedure, closure of the resulting TCF requires a specific technique of closure.…”

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.…”