Tracheostomy

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Abstract
In this paper a comparison has been made between excision-type window tracheostomies and classical Björk flap and modified flap tracheostomies, based upon a review of all tracheostomies performed at Harare Hospital, Salisbury, over a 20-month period, together with bronchoscopic follow-up whenever possible. The modified flap type of tracheostomy is constructed by means of a broad-based flap dividing two tracheal rings and having rounded corners. It produces a good stoma through which tube changing can be performed with ease and safety. Any form of permanent defect in the trachea left by merely extubating a tracheostomy will almost always produce a narrowing at the level of the stoma, which is probably most severe if a flap-type of stoma has been made. Routine replacement of a modified flap will nearly always avoid this. A serious stricture was produced in three (3%) patients in the series. In two, this was at the level of the tube tip in patients who had been on prolonged artificial ventilation; one required resection. These strictures are probably due to movement of the tube tip during ventilator therapy, and it is suggested that some method of coupling the ventilator to the tube might be devised to avoid this.