Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Oct;12(10):6185-6197.
doi: 10.21037/jtd.2020.02.41.

Tracheotomy, closure of long-term tracheostomy and standard tracheal segmental resections

Alper Toker  1 , J Awori Hayanga  1 , Ankit Dhamija  1 , Robert Herron  1 , Ghulam Abbas  1
Affiliations
Review

Tracheotomy, closure of long-term tracheostomy and standard tracheal segmental resections

Alper Toker et al. J Thorac Dis. 2020 Oct.

Abstract

Tracheotomy is a surgical procedure commonly employed to establish stable and long-term airway access. Iatrogenic airway injury post procedure may have serious consequences with limited treatment options. Tracheostoma or long standing tracheostomies require special closing techniques. Tracheotomies, tracheostomies, complications of these and treatment options, long standing tracheostomy closure techniques, and standard tracheal segmental resections are discussed.

Keywords: Tracheostomy; closure of tracheostomy; tracheal resections.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd.2020.02.41). The series “Airway Surgery” was commissioned by the editorial office without any funding or sponsorship. GA serves as the unpaid editorial board member of Journal of Thoracic Disease from Apr 2019 to Mar 2021. The other authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Trachea of an elderly kyphotic patient. The angle between sternum and trachea is almost 90 degrees.
Figure 2
Figure 2
Vertical tracheotomy over the 2nd and 3rd cartilages.
Figure 3
Figure 3
Flap tracheotomies are not recommended due to possible long-term complications.
Figure 4
Figure 4
Surgeon performs most of the procedure with one hand compressing the innominate artery and making the required dissections with the other hand until everything is under control.
Figure 5
Figure 5
Identification of the defect, closure or division but definitely exclusion from trachea is recommended. Some authors recommend to leave the fistoulous artery on the trachea by dividing the vessel from proximal and distal to the defect.
Figure 6
Figure 6
For the treatment of tracheoesophageal fistula resection of destructed trachea, primary closure of esophagus and muscle interposition are the mainstem of the treatment.
Figure 7
Figure 7
Dilatation of a stenosis is the first step of treatment in a patient. A tracheostomy or a reresection should not be performed if dilatation achieves success. Perforation of a trachea during dilatation may require an emergent operation.
Figure 8
Figure 8
Chest CT with three-dimensional reconstruction in the axial, coronal, and sagittal plans, the extent and location of tracheal injury may be mapped and assist with devising a treatment strategy.
Figure 9
Figure 9
Every millimeter is important in tracheal resections.
Figure 10
Figure 10
Operating room lights are turned off during bronchoscopy. So proper resection line could be planned. Remember “every mm is important”.
Figure 11
Figure 11
After the trachea is opened distally, a sterile ETT #8 is connected to the ventilatory tubing and handed off to the anesthesiologist. Oral ETT tube is pulled back, but still keeping in the limits of upper tracheal resection, a silk tie is attached to the distal hole of this tube.
Figure 12
Figure 12
Traction sutures may be used both at proximal and distal sites.
See this image and copyright information in PMC

References

    1. Pierson DJ. Tracheostomy from A to Z: historical context and current challenges. Respir Care 2005;50:473-5. - PubMed
    1. McClelland RM. Tracheostomy: its management and alternatives. Proc R Soc Med 1972;65:401-4. 10.1177/003591577206500442 - DOI - PMC - PubMed
    1. Tracheotomy Jackson C.. Laryngoscope 1909;19:285-90.
    1. Durbin CG, Jr. Early complications of tracheostomy. Respir Care 2005;50:511-5. - PubMed
    1. Epstein SK. Late complications of tracheostomy. Respir Care 2005;50:542-9. - PubMed