Lukas S Fiedler1, Peter Kress2, Sophie Wang3, Manuel Herbst4. 1. Otorhinolaryngology and Head and Neck Surgery, Klinikum Mutterhaus der Borromäerinnen Mitte, Feldstraße 16, 54290, Trier, Germany. lukas.fiedler@mutterhaus.de. 2. Otorhinolaryngology and Head and Neck Surgery, Klinikum Mutterhaus der Borromäerinnen Mitte, Feldstraße 16, 54290, Trier, Germany. 3. Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia. 4. Department Biometry and Bioinformatics, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany.
Abstract
INTRODUCTION: For decades, surgical tracheostomy using a Bjoerk-flap has been the standard procedure to create a reliable epithelialized tracheostomy in head and neck tumour surgery. This technique is being used as the gold standard approach in every surgical subspecialty. Preparation of the Bjoerk-flap requires splitting one or two tracheal rings, causing potential tracheal instability and tissue trauma. As a surgical alternative, the Visor-tracheostomy allows creating an epithelialized tracheostomy without splitting tracheal rings. This work aimed to prove the safety of the Visor-tracheostomy method, due to peri- and early postoperative complications. METHODS: We present a step-by-step approach of this "new tracheostomy method". Monocentric, retrospective data within 8 years were evaluated. Complications such as wound infection, tracheostoma bleeding, tracheostoma dehiscence, and via falsa in a total of 453 tracheostomies (161 Bjoerk-flap and 292 Visor-tracheostomies) were compared and the results were analysed descriptively. RESULTS: Our data did not reveal a statistically significant difference in risk for a complication between the two methods (Visor-tracheostomy vs. Bjoerk-flap; p = 0.60; OR = 1.26, 95%-CI 0.60-2.82). This supports the hypothesis that applying the new cartilage conserving Visor-tracheostomy does not result in a reduction of safety for the patient. CONCLUSION: We contend, that the Visor-tracheostomy has the potential to supersede other surgical tracheostomy techniques in some indications. LEVEL OF EVIDENCE: III (Comparative retrospective monocentric study).
INTRODUCTION: For decades, surgical tracheostomy using a Bjoerk-flap has been the standard procedure to create a reliable epithelialized tracheostomy in head and neck tumour surgery. This technique is being used as the gold standard approach in every surgical subspecialty. Preparation of the Bjoerk-flap requires splitting one or two tracheal rings, causing potential tracheal instability and tissue trauma. As a surgical alternative, the Visor-tracheostomy allows creating an epithelialized tracheostomy without splitting tracheal rings. This work aimed to prove the safety of the Visor-tracheostomy method, due to peri- and early postoperative complications. METHODS: We present a step-by-step approach of this "new tracheostomy method". Monocentric, retrospective data within 8 years were evaluated. Complications such as wound infection, tracheostoma bleeding, tracheostoma dehiscence, and via falsa in a total of 453 tracheostomies (161 Bjoerk-flap and 292 Visor-tracheostomies) were compared and the results were analysed descriptively. RESULTS: Our data did not reveal a statistically significant difference in risk for a complication between the two methods (Visor-tracheostomy vs. Bjoerk-flap; p = 0.60; OR = 1.26, 95%-CI 0.60-2.82). This supports the hypothesis that applying the new cartilage conserving Visor-tracheostomy does not result in a reduction of safety for the patient. CONCLUSION: We contend, that the Visor-tracheostomy has the potential to supersede other surgical tracheostomy techniques in some indications. LEVEL OF EVIDENCE: III (Comparative retrospective monocentric study).