Case report of permanent tracheostomy closure using costal cartilage

Abstract

We describe a 51-year-old woman in whom a persistent tracheocutaneous fistula after tracheostomy was closed using costal cartilage. The patient developed spontaneous bilateral chylothorax. She could not cough up chyle, and underwent tracheostomy. The secretions decreased after five years, and we decided to repair the tracheal defect with her consent. The defective tracheal cartilage was relatively large (3×1.2 cm), and so we planned to close the trans-cutaneous tissue defect using transplanted costal cartilage because direct suture was difficult. We harvested the seventh costal cartilage and created a graft that was slightly larger than the defect by trimming. We placed the graft on the tracheocutaneous fistula, keeping the divided face aligned at the tracheal lumen, and fixed it to the tracheal defect with 4-0 polydioxanone and interrupted sutures. She fasted and her speech was restricted for three days postoperatively to stabilize the implanted region, and she was discharged on postoperative day 7. Bronchoscopy at one and six months after surgery showed that the graft had survived and transitioned smoothly into the tracheal mucosa.