Starplasty
A New Technique of Pediatric Tracheotomy
Peter J. Koltai, MD
Arch Otolaryngol Head Neck Surg. 1998;124:1105-1111.
Objective To report a new technique of pediatric tracheotomy that reduces the problems of pneumothorax and recannulation after accidental decannulation in a recently performed tracheotomy.
Design Retrospective chart review for 1990-1997.
Patients Sixty-eight children aged between 2 days and 14 years.
Method The starplasty procedure is based on the geometry of a 3-dimensional Z-plasty. The technique of the procedure is described and illustrated in detail.
Results There were 27 short-term complications, including 4 accidental decannulations. There were no instances of pneumothorax or tracheotomy-related deaths. There were 25 long-term minor complications. There were no instances of tracheotomy-related death, suprastomal collapse, or tracheal stenosis. Thirty-eight children remain tracheotomy tube dependent, 17 underwent decannulation, 7 died of primary disease, and 6 were lost to follow-up. All 17 children who underwent decannulation have a persistent tracheocutaneous fistula.
Conclusions I conclude that starplasty reduces the incidence of major complications and death. Its only drawback seems to be persistent tracheocutaneous fistula.
From the Section of Pediatric Otolaryngology, Cleveland Clinic Foundation, Cleveland, Ohio.
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