A Comparative Analysis of Conventional Tracheotomy Versus Bjork Flap Tracheotomy

Background and objective Tracheotomy is a surgical technique performed in the anterior neck in various circumstances, such as prolonged endotracheal intubation, acute or persistent upper airway blockage, for bronchopulmonary toilet, or in certain otolaryngologic surgical procedures. In this study, we aimed to compare conventional and Bjork flap tracheotomy in terms of operative duration, as well as intraoperative, immediate postoperative, and delayed postoperative complications. Materials and methods A prospective study was conducted at a tertiary care hospital. The selected patients undergoing tracheotomies were randomly classified into two groups: conventional (n=30) and Bjork flap (n=30). Results Our findings indicated no statistically significant difference (p≥0.05) in terms of demographic profile (age and gender) between conventional (mean age: 52.3 ±12.79 years, male-to-female ratio: 25:5) and Bjork flap (mean age: 56.4 ±12.24 years, male-to-female ratio: 24:6) groups. A similar trend was observed in patients with respect to the duration of time required to establish access to the airway in both groups (7.8 ±1.73 and 7.7 ±1.87 minutes respectively, p≥0.05). However, a marked difference (p≤0.05) was observed in visual analog scale (VAS) scores between conventional and Bjork flap patients for ease of tube change (5.8 ±1.02-7.2 ±1.13 and 2.4 ±0.51-2.9 ±0.12) and stomal care (5.6 ±1.14-7.0 ±1.12 and 2.0 ±0.16-2.6 ±0.11) on the second and seventh day respectively. The Bjork flap-treated tracheotomy patients showed significantly favorable outcomes (p≤0.05) in intraoperative (immediate bleeding: 43%), postoperative (primary hemorrhage: 0%, subcutaneous emphysema: 6.7%), and delayed postoperative complications (stomal granulation: 10%, stomal stenosis: 3%, tracheostomy tube blockage: 10%, stoma infection: 10%, and secondary hemorrhage: 0%) as compared to their counterparts who underwent conventional tracheotomy: immediate bleeding: 70%; primary hemorrhage: 26.7%, subcutaneous emphysema: 30%; stomal granulation: 70%, stomal stenosis: 10%, tracheostomy tube blockage: 70%, stoma infection: 73%, and secondary hemorrhage: 3%. There was no significant difference with regard to tracheal stenosis and decannulation (p≥0.05) between the groups. Of the 25 decannulated patients, 50% (n=15) were in the conventional group and 33.3% (n=10) belonged to the Bjork flap group. Conclusion Based on our findings, Bjork flap tracheotomy is associated with fewer complications than conventional tracheotomy and may be preferred over conventional tracheotomy for elective tracheotomy procedures in adults.