Surgical Techniques for Closure of Tracheostoma.

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  • 気管孔閉鎖術の臨床的検討

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Tracheotomies are commonly preformed in medical institution. In general, the tracheotomized stoma spontaneously closes after removal of the tracheostomy tube. However, surgical closure is necessary in some cases. The procedures for stoma closure are not well documented. We describe our method in this report.<br>Seven tracheotomies (3 males and 4 females, mean age ; 56.8 years) performed between 1996 and 2000 were analyzed. The stoma did not close spontaneously even 5 months or more after removal of the tracheostomy tube in these cases. MRSA was detected from the culture collected from the stoma in all of these cases.<br>Stoma closure was conducted under local anesthesia. Three skin flaps were prepared including two hinge flap, one on the right and the other on the left side of the stoma, and a skin flap to cover the skin defect. Stenosis of the trachea did not occur in any of the cases, which was confirmed by postoperative endoscopy.<br>The advantages of our method include 1) minimal surgical invasion, 2) minimal chance of stenosis of the lumen ; and 3) low risk of associated infection. Its shortcomings are 1) it may not be suitable for tracheotomies in head and neck malignancy cases or after irradiation ; and 2) the scar may inhibit laryngeal elevation, and thus may cause aspiration.

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