AIMS AND BACKGROUND:
Surgical tracheostomy is a common procedure utilized across multiple surgical specialities for airway control. Despite its common practice, there is wide variation in the technique of incision in the tracheal cartilage. So far there has not been an established superior technique. Narrowing of the airway is a significant post-operative complication. It has been estimated that tracheal stenosis represent up to 28% of tracheostomy-related. We aim to see if there is a superior technique with regards to this primary outcome.
METHDOS:
A systematic review according to the PRISMA protocol was completed comparing the type of tracheal incision (Transverse, vertical, Cartilage excision, Bjork Flap) and comparing the rate of post-operative stenosis. Main inclusion criteria are patients undergoing surgical tracheostomy and there has to be a specific and well defined technique of entry into the tracheal lumen. Main exclusion criteria: percutaneous approach and paediatric population.
RESULTS:
A Total of 13 papers met the inclusion criteria; totalling 2994 tracheostomies (455 Horizontal, 1888 Bjork flap, 444 Cartilage excision, 204 superiorly based flap and 3 vertical flaps). 2 papers were comparative and 11 papers were descriptive and retrospective. Overall rate of tracheal stenosis is 0.68%.
CONCLUSIONS:
There is paucity of good quality evidence for more superior technique. Bjork flap appears is marginally better with reduced rate of post-operative stenosis compared to other techniques.