Name of the Procedure:

Tracheostoma Revision; Complex, with Flap Rotation
Also known as: Tracheostomy revision with local flap rotation

Summary

A tracheostoma revision with flap rotation is a surgical procedure to correct or improve a tracheostomy opening (stoma). It involves the use of local tissue flaps to reconstruct and enhance the stoma, ensuring it functions properly and minimizes complications.

Purpose

This procedure addresses issues related to an existing tracheostomy, such as stoma stenosis (narrowing), irregularities, excessive scarring, or tissue breakdown. The goal is to ensure a stable, functional tracheostomy with an improved airway, reduced risk of infection, and better overall patient comfort.

Indications

• Stenosis or narrowing of the tracheostoma
• Irregularities in the shape or structure of the stoma
• Excessive scarring around the tracheostomy site
• Persistent infection or granulation tissue formation
• Breakdown of surrounding tissues

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments in medications, especially blood thinners.
• Preoperative assessments, including blood tests and imaging of the tracheostomy site.
• A thorough medical evaluation to ensure fitness for anesthesia.

Procedure Description

1. Anesthesia: Administering general anesthesia for patient comfort.
2. Incision and Exposure: Making an incision around the existing tracheostoma.
3. Flap Rotation: Carefully rotating local tissue flaps and repositioning them to reconstruct the tracheostomy site.
4. Reshaping the Stoma: Reconfiguring the stoma to improve its structure and function.
5. Closure: Suturing the new flap in place and closing the surgical site with minimal tension.

Tools and Equipment: Scalpel, sutures, surgical scissors, retractors, cautery devices

Duration

The procedure typically takes 1 to 2 hours.

Setting

Performed in a hospital operating room or specialized surgical center.

Personnel

• Primary Surgeon (specializing in ENT or thoracic surgery)
• Anesthesiologist
• Operating Room Nurses
• Surgical Technologists

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Flap necrosis (tissue death)
• Recurrence of stenosis
• Airway obstruction or difficulty breathing
• Scarring and alteration in voice

Benefits

• Enhanced airway stability
• Reduced risk of infection and other complications
• Improved aesthetic appearance of the stoma
• Enhanced patient comfort and quality of life

Recovery

• Monitoring in a recovery room until fully awake and stable.
• Instructions on stoma care, including cleaning and maintenance.
• Pain management with prescribed medications.
• Avoidance of heavy activities for several weeks.
• Follow-up appointments for evaluation and suture removal.

Alternatives

• Simple tracheostomy revision without flap rotation
• Laser surgery for minor revisions
• Stent placement to keep the airway open

Pros and Cons:

• Simple Revision: Less invasive but may not address complex issues.
• Laser Surgery: Minimally invasive but limited to less severe cases.
• Stent Placement: Quick method but requires frequent monitoring.

Patient Experience

• Mild to moderate pain managed with medications.
• Swelling and bruising around the surgical site.
• Possible sore throat or voice changes initially.
• Detailed care instructions provided for the stoma.
• Gradual improvement in breathing and comfort over several weeks.