RESUMEN
Exploring the Role of Cap Grafts in tracheocutaneous fistula Closure. A tracheocutaneous fistula (TCF) is an abnormal connection that forms between the trachea (windpipe) and the skin of the neck. If spontaneous closure does not occur, fibrosis of the surrounding tissue may result in a persistent TCF and in some cases, iatrogenic laryngotracheal stenosis at the level of tracheostoma, the so-called A-frame deformity. In all 5 patients, Conchal cartilage was harvested. The new de-epithelialized stoma is measured, and the previously harvested graft is cut to match the defect. Passing through the centre of the tracheal cartilage and into the centre of the auricular cartilage graft, 3-0 PDS, horizontal mattress sutures are placed sequentially around the periphery of the graft, stabilised with Right SCM flap and skin was closed in layers. In each of the five cases, we achieved a resounding success by skilfully closing the fistulas and meticulously restoring the structural integrity. Equally noteworthy, all patients expressed contentment with the cosmetic outcomes at both the donor site and the neck region, deeming it as an acceptable aesthetic result.
RESUMEN
Objectives: To determine the incidence of A-frame deformity and suprastomal collapse after pediatric tracheostomy. Study design: Retrospective cohort. Methods: All patients (<18 years) that had a tracheostomy placed at a tertiary institution between 2015 and 2020 were included. Children without a surveillance bronchoscopy at least 6 months after tracheostomy were excluded. Operative reports identified tracheal A-frame deformity or suprastomal collapse. Results: A total of 175 children met inclusion with 18% (N = 32) developing A-frame deformity within a mean of 35.8 months (SD: 19.4) after tracheostomy. For 18 children (18/32, 56%), A-frame developed within a mean of 11.3 months (SD: 15.7) after decannulation. There were 96 children developing suprastomal collapse (55%) by a mean of 17.7 months (SD: 14.2) after tracheostomy. All suprastomal collapse was identified prior to decannulation. Older age at tracheostomy was associated with a lower likelihood of collapse (OR: 0.92, 95% CI: 0.86-0.99, p = .03). The estimated 5-year incidence of A-frame deformity after tracheostomy was 32.8% (95% CI: 23.0-45.3) and the 3-year incidence after decannulation was 36.1% (95% CI: 24.0-51.8). Highly complex children had an earlier time to A-frame development (p = .04). At 5 years after tracheostomy, the estimated rate of suprastomal collapse was 73.7% (95% CI: 63.8-82.8). Conclusions: Tracheal A-frame deformity is estimated to occur in 36% of children within 3 years after tracheostomy decannulation. Suprastomal collapse, which approaches 74% at 5 years after tracheostomy, is more common when tracheostomy is placed at a younger age. Surgeons caring for tracheostomy-dependent children should recognize acquired airway obstruction and appropriately monitor these outcomes. Level of evidence: 3.