Closure of persistent tracheocutaneous fistula following "starplasty" tracheostomy in children.
OBJECTIVE
The "starplasty" technique of pediatric tracheostomy was introduced in 1990 as an alternative pediatric tracheostomy technique associated with several advantages. The only apparent drawback of this technique is the higher incidence of persistent tracheocutaneous fistula following decannulation. Several methods have been proposed for closure of persistent tracheocutaneous fistula in children, including fistulectomy with primary closure and fistulectomy with healing by secondary intent. Some authors advocate placement of a drain at the time of primary closure. We present our experience with closure of persistent tracheocutaneous fistula following starplasty in children over the past 15 years.


METHODS
Ninety-six starplasty procedures were performed on 96 children from 1990 to present, all by the senior author or under the guidance of the senior author. Twenty-eight of these children have been decannulated. Three fistulas closed spontaneously following decannulation. Of the remaining 25 children, 13 have undergone surgical closure of the tracheocutaneous fistula by the senior author. All tracheocutaneous fistula closures were performed as a fistulectomy with primary closure in three layers. Drains were not used in any of the patients.


RESULTS
There were three minor complications in the postoperative period (wound infection and airway granuloma) and no major complications. None of the patients have experienced any degree of airway stenosis and there was no need for a repeat tracheotomy in any of the tracheocutaneous fistula closure patients. The cosmetic results were deemed to be good.


CONCLUSIONS
"Starplasty" is a safe, reliable pediatric tracheostomy technique that has been shown to decrease the incidence of perioperative morbidity and mortality. The only drawback appears to be a high incidence of postoperative tracheocutaneous fistula. Our method of persistent tracheocutaneous fistula closure following starplasty is safe and effective, with no major complications and no incidence of postoperative airway narrowing.
Cleveland Clinic Foundation, Head and Neck Institute, 9500 Euclid Avenue, Desk A71, Cleveland, OH 44195, USA. sautten@ccf.org
Nathan B
NB
Sautter
Paul R
PR
Krakovitz
C Arturo
CA
Solares
Peter J
PJ
Koltai
D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000209:etiology* / Q000601:surgery; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D016156:Respiratory Tract Fistula / Q000209:etiology* / Q000601:surgery; D014133:Tracheal Diseases / Q000209:etiology* / Q000601:surgery; D014139:Tracheostomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome