title: Starplasty: revisiting a pediatric tracheostomy technique.
abstract: OBJECTIVE
  To determine the efficacy the "starplasty" pediatric tracheostomy technique in reducing the incidence of major complications and tracheotomy-related death.
  
  
  METHODS
  Retrospective chart analysis of all the cases of starplasty performed at 2 tertiary care centers between 1990 and 2002.
  
  
  RESULTS
  There were 94 children in our cohort ranging in age from 2 days to 14 years. Of the patients, 47 (50%) were females and 47 (50%) were males and 60 of the children (64%) were younger than 1 year of age. Forty-one patients (44%) had neurologically related airway problems as their primary indication for tracheostomy, 34 (36%) had upper airway obstruction, and the remainder had pulmonary diseases, prolonged intubation, or metabolic-related airway problems. There were 41 short-term complications including 5 cases of tracheal tube dislodgement. There were no instances of pneumothorax or tracheostomy-related death. There were 26 long-term complications. There were no cases of clinically relevant suprastomal collapse that compromised decannulation and no instances of tracheal stenosis. Twenty-six patients underwent decannulation, all of whom developed a tracheocutaneous fistula (TCF). Two patients had spontaneous closure of the TCF; 9 patients underwent surgical repair of their fistulas, 53 patients remain tracheostomy-dependent, and 8 patients died of their primary disease.
  
  
  CONCLUSIONS
  The need for pediatric tracheotomy has increased as a consequence of our success in treating chronically ill children. Starplasty reduces the incidence of major complications, including pneumothorax and death from accidental decannulation. Its major drawback is the need for secondary reconstruction of a tracheocutaneous fistula.
  
  
  METHODS
  C.
authors.affiliation: The Cleveland Clinic Foundation, Section of Pediatric Otolaryngology, Head and Neck Institute, Cleveland, OH, USA.
authors.forename: C Arturo
authors.initials: CA
authors.lastname: Solares
authors.forename: Paul
authors.initials: P
authors.lastname: Krakovitz
authors.forename: Keiko
authors.initials: K
authors.lastname: Hirose
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koltai
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D014133:Tracheal Diseases / Q000209:etiology; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome