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Preserving the thyroidal isthmus during low tracheostomy with creation of a Björk flap

OBJECTIVES/HYPOTHESIS: Surgical tracheostomy (ST) with creation of an inferiorly based U‐shaped tracheal flap, known as the Björk flap, is the most commonly performed. The purpose of this study was to evaluate whether outcome was different in patients who underwent low ST with retraction and preserv...

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Autores principales: Janik, Stefan, Kliman, Jonathan, Hacker, Philipp, Erovic, Boban M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585656/
https://www.ncbi.nlm.nih.gov/pubmed/30284245
http://dx.doi.org/10.1002/lary.27310
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author Janik, Stefan
Kliman, Jonathan
Hacker, Philipp
Erovic, Boban M.
author_facet Janik, Stefan
Kliman, Jonathan
Hacker, Philipp
Erovic, Boban M.
author_sort Janik, Stefan
collection PubMed
description OBJECTIVES/HYPOTHESIS: Surgical tracheostomy (ST) with creation of an inferiorly based U‐shaped tracheal flap, known as the Björk flap, is the most commonly performed. The purpose of this study was to evaluate whether outcome was different in patients who underwent low ST with retraction and preservation of the thyroid isthmus compared to those who underwent high ST with ligation of the thyroid isthmus. STUDY DESIGN: Retrospective cohort study. METHODS: We included 1,143 patients who underwent ST with creation of a Björk flap between 2008 and 2015. Different outcome parameters, including complications, decannulation, inpatient mortality, and surgical characteristics, such as length of surgery and height of tracheal incision, were assessed comparing low and high ST. RESULTS: Complications occurred in 7.7% of patients, of which persistent stoma (4.1%) and hemorrhages (2.7%) were the most common. Low tracheostomy with retraction and preservation of thyroid isthmus was done in 31.4% of cases. Complications did not significantly differ between low and high tracheostomies (8.0% vs. 7.0%, P = .468). Moreover, decannulation rate and inpatient mortality were also not significantly different in low compared to high tracheostomies (P = .816 and P = .152, respectively). However, low tracheostomies were associated with significantly shorter operation times (33.0 ± 0.8 min vs. 38.7 ± 0.5 min, P < .001) and lower tracheal incisions for creation of a Björk flap (P < .001) compared to high tracheostomies. CONCLUSIONS: Low tracheostomies are as safe as high tracheostomies regarding complications. Due to the fact that low tracheostomies are associated with shorter operation times and lower tracheal incisions, we recommend performong low tracheostomies whenever feasible. LEVEL OF EVIDENCE: 4 Laryngoscope, 128:2783–2789, 2018
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spelling pubmed-65856562019-06-27 Preserving the thyroidal isthmus during low tracheostomy with creation of a Björk flap Janik, Stefan Kliman, Jonathan Hacker, Philipp Erovic, Boban M. Laryngoscope Head and Neck OBJECTIVES/HYPOTHESIS: Surgical tracheostomy (ST) with creation of an inferiorly based U‐shaped tracheal flap, known as the Björk flap, is the most commonly performed. The purpose of this study was to evaluate whether outcome was different in patients who underwent low ST with retraction and preservation of the thyroid isthmus compared to those who underwent high ST with ligation of the thyroid isthmus. STUDY DESIGN: Retrospective cohort study. METHODS: We included 1,143 patients who underwent ST with creation of a Björk flap between 2008 and 2015. Different outcome parameters, including complications, decannulation, inpatient mortality, and surgical characteristics, such as length of surgery and height of tracheal incision, were assessed comparing low and high ST. RESULTS: Complications occurred in 7.7% of patients, of which persistent stoma (4.1%) and hemorrhages (2.7%) were the most common. Low tracheostomy with retraction and preservation of thyroid isthmus was done in 31.4% of cases. Complications did not significantly differ between low and high tracheostomies (8.0% vs. 7.0%, P = .468). Moreover, decannulation rate and inpatient mortality were also not significantly different in low compared to high tracheostomies (P = .816 and P = .152, respectively). However, low tracheostomies were associated with significantly shorter operation times (33.0 ± 0.8 min vs. 38.7 ± 0.5 min, P < .001) and lower tracheal incisions for creation of a Björk flap (P < .001) compared to high tracheostomies. CONCLUSIONS: Low tracheostomies are as safe as high tracheostomies regarding complications. Due to the fact that low tracheostomies are associated with shorter operation times and lower tracheal incisions, we recommend performong low tracheostomies whenever feasible. LEVEL OF EVIDENCE: 4 Laryngoscope, 128:2783–2789, 2018 John Wiley and Sons Inc. 2018-10-03 2018-12 /pmc/articles/PMC6585656/ /pubmed/30284245 http://dx.doi.org/10.1002/lary.27310 Text en © 2018 The Authors. The Laryngoscope published by Wiley Periodicals, Inc. on behalf of The American Laryngological, Rhinological and Otological Society, Inc. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Head and Neck
Janik, Stefan
Kliman, Jonathan
Hacker, Philipp
Erovic, Boban M.
Preserving the thyroidal isthmus during low tracheostomy with creation of a Björk flap
title Preserving the thyroidal isthmus during low tracheostomy with creation of a Björk flap
title_full Preserving the thyroidal isthmus during low tracheostomy with creation of a Björk flap
title_fullStr Preserving the thyroidal isthmus during low tracheostomy with creation of a Björk flap
title_full_unstemmed Preserving the thyroidal isthmus during low tracheostomy with creation of a Björk flap
title_short Preserving the thyroidal isthmus during low tracheostomy with creation of a Björk flap
title_sort preserving the thyroidal isthmus during low tracheostomy with creation of a björk flap
topic Head and Neck
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585656/
https://www.ncbi.nlm.nih.gov/pubmed/30284245
http://dx.doi.org/10.1002/lary.27310
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