Innominate artery erosion complicating use of tracheal tube with adjustable flange

A tracheal tube having an adjustable flange (AF tube) can be adjusted in cases of abnormal depth from skin to trachea. In a 43-year-old man with squamous cell carcinoma of the floor of the mouth, an AF tube was inserted because of severe edema of pretracheal tissues. He developed innominate artery erosion on the 6th postoperative day caused by the malfitted AF tube and died of recurrent hemorrhage 5 days after a surgical repair of the wound. The AF tube should be utilized not routinely but only in individuals with abnormal anatomy of the neck or trachea. Use of the AF tube requires extra care in addition to routine care required in the case of a conventional tracheal tube. Its correct fit should be verified initially by radiography. Fiberoptic examination should be employed within days after tracheostomy for patients with an AF tube to determine whether the tracheal mucosa is intact.