Name of the Procedure:

Tracheostoma revision; simple, without flap rotation (Tracheostomy site revision)

Summary

A tracheostoma revision is a surgical procedure aimed at correcting issues related to a pre-existing tracheostomy site. This revision does not include flap rotation, meaning it is a less complex approach to address problems such as stenosis (narrowing) or infection at the tracheostomy site.

Purpose

This procedure is primarily conducted to resolve complications at the tracheostomy site, including:

• Narrowing of the tracheostomy opening (stenosis) which can impede breathing.
• Infections or persistent inflammation.
• Abnormal tissue growth around the tracheostomy site.

The goal is to improve the function and health of the tracheostoma, enabling easier breathing and reducing the risk of future complications.

Indications

Patients may require tracheostoma revision for the following reasons:

• Difficulty breathing due to narrowing of the tracheostoma.
• Recurrent infections around the tracheostomy site.
• Excessive granulation tissue or scar formation.
• Poor fit of tracheostomy tube due to anatomical changes.

Preparation

• Patients should fast for at least 6-8 hours before the procedure.
• Blood tests, imaging studies, and potentially a bronchoscopy may be necessary for planning the revision.
• Any blood-thinning medications should be adjusted or paused as per physician recommendations.

Procedure Description

1. The patient is positioned and given anesthesia to ensure comfort and immobility.
2. The surgical site is sterilized.
3. The surgeon makes an incision around the existing tracheostoma.
4. Scar tissue and abnormal growths are carefully removed.
5. The tracheostoma is reshaped and resized to ensure a proper opening.
6. The area is sutured as necessary to maintain the new shape.

No flap rotation is involved, which makes the procedure less complex and typically shorter.

Duration

The procedure typically takes about 1-2 hours.

Setting

The procedure is generally performed in a hospital operating room or specialized surgical center.

Personnel

• ENT (Ear, Nose, and Throat) surgeon or a specialized tracheostomy surgeon.
• Anesthesiologist.
• Surgical nurses or operating room technicians.

Risks and Complications

• Infection.
• Bleeding.
• Difficulty breathing post-surgery due to swelling or improper healing.
• Scar formation or granulation tissue recurrence.
• Damage to surrounding tissues (rare).

Benefits

• Improved airway patency and easier breathing.
• Reduced risk of recurrent infections.
• Enhanced fit and comfort of the tracheostomy tube.
• Improved overall health and quality of life.

Benefits are generally realized within weeks to a few months post-surgery.

Recovery

• Patients may need to stay in the hospital for observation for a few days.
• Pain management will be provided as necessary.
• Instructions on wound care, activity restrictions, and follow-up appointments will be given.
• Avoid heavy lifting, strenuous activity, and ensure regular follow-ups for proper healing.

Alternatives

• Conservative management with medications and wound care.
• More complex surgical revisions with flap rotation.
• Laser therapy to remove granulation tissue.

Alternatives may have varying success rates and risks. A discussion with the surgeon is essential to determine the best plan of action.

Patient Experience

Patients will be under anesthesia during the procedure and should not feel any pain. Post-procedure, they may experience some discomfort or mild pain, which can be managed with medication. Most patients report significant improvements in breathing and a reduction in symptoms associated with their tracheostomy complications. Complete recovery can take several weeks to months, depending on the individual healing process and adherence to post-operative care instructions.