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Tracheocutaneous Fistula After Pediatric Open Airway Reconstruction
Stephen R Chorney1,2, Joanne Stow3, Luv R Javia3,4
1Department of Otolaryngology - Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Insights
Persistent tracheocutaneous fistula (TCF) is common after pediatric airway reconstruction, affecting 85% of children. Smaller tracheostomy tubes and stents may promote spontaneous closure, but surgical intervention is often required.
Area of Science:
- Pediatric Otolaryngology
- Airway Reconstruction
- Tracheostomy Management
Background:
- Tracheocutaneous fistula (TCF) is a frequent complication following pediatric tracheostomy decannulation.
- The persistence of TCF after staged open airway reconstruction is not well-documented.
Purpose of the Study:
- To determine the rate of persistent TCF in children after successful decannulation.
- To identify factors associated with TCF persistence or spontaneous closure.
Main Methods:
- A retrospective case series involving chart review of pediatric patients.
- Patients underwent decannulation after double-stage laryngotracheal reconstruction between 2017 and 2019.
Main Results:
- 84.6% of 26 children experienced persistent TCF post-decannulation.
- Spontaneous closure occurred in 15.4% by one month.
- Larger tracheostomy tube and stent diameters correlated with TCF persistence (P<0.05).
- Surgical closure was successful in 93.8% of cases.
Conclusions:
- Persistent TCF is highly prevalent (85%) after staged pediatric airway reconstruction.
- Spontaneous closure is possible within one month and influenced by device size.
- Families should be informed about TCF frequency and potential need for surgical closure.
Objectives:
Tracheocutaneous fistula (TCF) is a common occurrence after pediatric tracheostomy decannulation. However, the persistence of TCF after staged reconstruction of the pediatric airway is not well-described. The primary objective was to determine the rate of persistent TCF after successful decannulation in children with staged open airway reconstruction.
Methods:
A case series with chart review of children who underwent decannulation after double-stage laryngotracheal reconstruction between 2017 and 2019.
Results:
A total of 26 children were included. The most common open airway procedure was anterior and posterior costal cartilage grafting (84.6%, 22/26). Median age at decannulation was 3.4 years (IQR: 2.8-4.3) and occurred 7.0 months (IQR: 4.3-10.4) after airway reconstruction. TCF persisted in 84.6% (22/26) of children while 15.4% (4/26) of stomas closed spontaneously. All closures were identified by the one-month follow-up visit. There was no difference in age at tracheostomy (P = .86), age at decannulation (P = .97), duration of tracheostomy (P = .43), or gestational age (P = .23) between stomas that persisted or closed. Median diameter of stent used at reconstruction was larger in TCFs that persisted (7.0 mm vs 6.5 mm, P = .03). Tracheostomy tube diameter (P = .02) and stent size (P < .01) correlated with persistence of TCF on multivariable logistic regression analysis. There were 16 surgical closure procedures, which occurred at a median of 14.4 months (IQR: 11.4-15.4) after decannulation. Techniques included 56.3% (9/16) by primary closure, 18.8% (3/16) by secondary intention and 25% (4/16) by cartilage tracheoplasty. The overall success of closure was 93.8% (15/16) at latest follow-up.
Conclusions:
Persistent TCF occurs in 85% of children who are successfully decannulated after staged open airway reconstruction. Spontaneous closure could be identified by 1 month after decannulation and was more likely when smaller stents and tracheostomy tubes were utilized. Surgeons should counsel families on the frequency of TCF and the potential for additional procedures needed for closure.
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