永久気管孔狭窄への対処

抄録

We have treated 6 patients with tracheostomal stenosis for the last 5 years. Permanent tracheostomata were created during total laryngectomy in 5 adult patients, and during laryngotracheal separation in a pediatric patient with congenital multiform arthrogryposis. In most cases, stenosis occurred in a month or two after the surgery, while it developed when systemic skin rash occurred in 2 patients whose stomal size had been stable for a fairly long time.
Stomal stenosis can be defined as a scar contracture developed along a circular suture line. Therefore the surgical strategy against the stenosis of stoma should be the same as that of general scar formation in the skin. Taking this into account, the two following policies can be selected: One is Z-plasty and its modification or transposition of local flaps only to reposition and relax the line of contracture. The other is a complete removal of the cicatrical tissues to eradicate the lesion. If any contributing factors to stenosis remain, the choice should be the former. Therefore, we have employed the interposition of four paired triangular flaps regardless of stomal configuration. However, there seems to be no satisfactory solution at present against stomal stenosis due to hypertrophic scars or keloids. Systemic approach considering precipitating factors of stenosis is essential.
An ideal stoma does not necessarily mean a wide one. Patients in this study have insisted the adequate size of 14-20 mm vertically and 12-18 mm horizontally, which is almost the same diameter as the trachea. The critical size where every adult patient has complained to be dyspneic was less than 10mm×8mm.