Starplasty: a new technique of pediatric tracheotomy.
OBJECTIVE
To report a new technique of pediatric tracheotomy that reduces the problems of pneumothorax and recannulation after accidental decannulation in a recently performed tracheotomy.


METHODS
Retrospective chart review for 1990-1997.


METHODS
Sixty-eight children aged between 2 days and 14 years.


METHODS
The starplasty procedure is based on the geometry of a 3-dimensional Z-plasty. The technique of the procedure is described and illustrated in detail.


RESULTS
There were 27 short-term complications, including 4 accidental decannulations. There were no instances of pneumothorax or tracheotomy-related deaths. There were 25 long-term minor complications. There were no instances of tracheotomy-related death, suprastomal collapse, or tracheal stenosis. Thirty-eight children remain tracheotomy tube dependent, 17 underwent decannulation, 7 died of primary disease, and 6 were lost to follow-up. All 17 children who underwent decannulation have a persistent tracheocutaneous fistula.


CONCLUSIONS
I conclude that starplasty reduces the incidence of major complications and death. Its only drawback seems to be persistent tracheocutaneous fistula.
Section of Pediatric Otolaryngology, Cleveland Clinic Foundation, Ohio 44195, USA.
P J
PJ
Koltai
D000293:Adolescent; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000453:epidemiology; D005260:Female; D005402:Fistula / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013536:Suture Techniques; D014133:Tracheal Diseases / Q000453:epidemiology; D014140:Tracheotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*