Double reversing Z-plasty with inferiorly widening stomaplasty for the management of tracheostomal stenosis

Abstract

OBJECTIVES: To present a surgical technique for the management of tracheostomal stenosis: double reversing Z-plasty with inferiorly widening stomaplasty.

METHODS: This study was a retrospective review of five patients (four males, one female) submitted for tracheostomal widening procedure using "double reversing Z-plasty with inferiorly widening stomaplasty" at our department between May 2003 and April 2009. Skin incision was made on each lateral side of the stoma. The skin flap was elevated, and the subcutaneous and scar tissue at the infrastomal area was removed along with the redundant skin. Vertical incision was made on each side of the trachea as a mirror image, and the trachea was splayed. The inferiorly mobilized trachea was sutured to the new tissue bed inferior to the stoma, and both skin flaps were secured to the depths of the tracheal cut (double reversing Z-plasty).

RESULTS: All five patients showed widened tracheostoma without any complications, and their phonatory prostheses functioned well after the procedure. In no case was it necessary to keep the tracheal tubes beyond the first day after the surgery.

CONCLUSION: This technique, "double reversing Z-plasty with inferiorly widening stomaplasty", provides a safe procedure for enlarging the tracheostomal size and easing the excessive tension without disturbing the posterosuperior stomal profile and the tracheoesophageal puncture for phonatory prosthesis.