Tracheostomy Closure and Scar Revisions

Primary closure of persistent tracheocutaneous fistula in pediatric patients

“…The incidence of fistula formation is related to the duration of cannulation. Kulber et al [4] reported that a fistula does not develop when cannulation is less than 16 weeks, but incidence increases to 70% when the cannulation period is greater than 16 weeks. The increasing incidence of persistent fistula formation after decannulation may reflect the changing indications for tracheostomy [5].…”

Management of the Post‐Tracheostomy Scar

“…Though this technique corrects the depression and tracheal tug, it requires deep dissection and manipulation. In 1972, Kulber and Passy described mobilizing strap muscles and reapproximating them midline to achieve the same goals 5 . To further avoid tracheal tug with layer re‐approximation, acellular dermal grafts can be placed between muscle and subcutaneous tissues as first described by Carlson et al in 1991 6,7 .…”

“…In 1972, Kulber and Passy described mobilizing strap muscles and reapproximating them midline to achieve the same goals. 5 To further avoid tracheal tug with layer re-approximation, acellular dermal grafts can be placed between muscle and subcutaneous tissues as first described by Carlson et al in 1991. 6,7 We found that tracheal tug and scar depression can be best resolved by reapproximating deep tissue layers, including the strap muscles, and by scar de-epithelialization.…”

A novel technique for closing a tracheocutaneous fistula using a hinged skin flap

“…Prolonged cannulation, however, can signifi cantly increase the risk of developing a persistent fi stula. Kulber et al 2 reported that 70% of tracheostomies present for more than 16 weeks resulted in tracheocutaneous fi stulas. In general, the reported occurrence rate of such fi stulas ranges from 3.3% to 29%, 3 and local wound care and plastic reconstruction strategies are required in such cases.…”