Closing a Tracheostomy: Step-by-Step Dissection, Pearls and Pitfalls and Complications

  • Matthaeus Ch. GraslEmail author
  • Boban M. Erovic


Decannulation and tracheostoma closure depend on the primary disease and its further development. With the tracheostoma closure, special medical and management requirements must be met, and contraindications need to be observed. Possibilities for predicting successful tracheostoma closure are described in the chapter in detail and pearls and pitfalls are given. Rare complications and how-to-avoid them are discussed. Non-epithelialized tracheostomies after PDT show tendencies towards spontaneous closure. If this is not the case or if the stoma is epithelialized, a surgical closure has to be performed. In this chapter, numerous surgical techniques how to close a persistent tracheostomy are presented, including adults and children and the oversized stoma, with a detailed step-by-step description and figures.


Tracheostomal closure Techniques in adults and children Performing Complications Skin flaps Oversized tracheostoma 


  1. 1.
    Wenzel S, Sagowski C, Kehrl W, Hessler C, Metternich FU. Life-threatening complications after plastic tracheostomy closure. Which length of hospital stay according to clinical and forensic viewpoints is necessary? HNO. 2004;11:979–83. German.Google Scholar
  2. 2.
    Delank KW, Sittel C, Betz C, Heinrich D, Eßer D. Die Qualität der ambulanten Tracheostomaversorgung in Deutschland. In: 88. Jahresversammlung der Deutschen Gesellschaft für Hals-, Nasen-, Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V. Erfurt 27.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. Doc 17hno009.
  3. 3.
    Byhahn C, Lischke V, Westphal K, editors. Tracheotomie. Indikationen und Anwendung in der Intensivmedizin. Darmstadt: Steinkopf; 2000.Google Scholar
  4. 4.
    Gurbani N, Promyothin U, Rutter M, Fenchel MC, Szczesniak RD, Simakajornboon N. Using polysomnography and airway evaluation to predict successful detracheostmy tubetion in children. Otolaryngol Head Neck Surg. 2015;153(4):649–55.CrossRefGoogle Scholar
  5. 5.
    Lopez-Pastorini A, Kraja O, Ludwig C, Plönes T, Storre JH, Rommel T, Riecker A, Stoelben E. Reduction of tracheotomy associated tracheal stenosis by surgical closure of the tracheostomy. Pneumologie. 2015;69:335–40. German.Google Scholar
  6. 6.
    Grant N, Davison SP. Management of the post-tracheostomy scar. Laryngoscope. 2007;117:2107–9.CrossRefGoogle Scholar
  7. 7.
    Drezner AD, Cantrell H. Surgical management of tracheocutaneous fistula. Ear Nose Throat J. 1998;77:534–7.CrossRefGoogle Scholar
  8. 8.
    Khaja SF, Fletcher AM, Hoffman HT. Local repair of persistent tracheocutaneous fistulas. Ann Otol Rhinol Laryngol. 2011;120:622–6.CrossRefGoogle Scholar
  9. 9.
    Berghaus A, Handrock M, Matthais R. Unser Konzept bei Anlage und Wiederverschluss eines Tracheostoma. HNO. 1984;32:217–20.PubMedGoogle Scholar
  10. 10.
    Mickelsson SA, Rosenthal L. Closure of permanent tracheostomy in patients with sleep apnoea: a comparison of two techniques. Otolaryngol Head Neck Surg. 1997;116:36–40.CrossRefGoogle Scholar
  11. 11.
    Donald PJ. Trachealchirurgie. In: Naumann HH, Herberhold C, Panje WR, editors. Kopf- und Hals-Chirurgie, Vol 3 Hals, 2nd ed. Thieme Stuttgart New York; 1998. pp. 243–82.Google Scholar
  12. 12.
    Masing H, Weidenbecher M. Zur Indikation und Technik des epithelisierten Tracheostomas. In: Rügheimer E, editor. Intubation, Tracheotomie und bronchopulmonale Infektion. Berlin: Springer; 1983.Google Scholar
  13. 13.
    Grant N, Davison SP. Management of the post-tracheostomy scar. Laryngoscope. 2007;117:2107–9.CrossRefGoogle Scholar
  14. 14.
    Werner J. Eingriffe an Kehkopf, Hypopharynx und Trachea. In: Theissing J, Rettinger G, Werner J, Hrsg. HNO-Operationslehre. 4th ed. Thieme Stuttgart New York; 2006. pp. 225–6.Google Scholar
  15. 15.
    Björk VO. Partial resection of the only remaining lung with the aid of respirator treatment. J Thorac Cardiaovasc Surg. 1960;39:179–88.Google Scholar
  16. 16.
    Hammarfjord O, Ekanayake K, Norton J, Stassen LF. Limited dissection and early primary closure of the tracheostomy stoma in head and neck oncology operations: a retrospective study of 158 cases. Int J Oral Maxillifac Surg. 2015;44:297–300.CrossRefGoogle Scholar
  17. 17.
    Eliashar R, Sichel JY, Eliashar I. A new surgical technique for primary closure of long-term tracheotomy. Otolaryngol Head Neck Surg. 2005;132:115–8.CrossRefGoogle Scholar
  18. 18.
    Bootz F. Plastic tracheostomy closure. Laryngorhinootologie. 1991;70(1):48. German.Google Scholar
  19. 19.
    Corbett HJ, Mann KS, Mitra I, Jesudason EC, Losty PD, Clake RW. Tracheostomy – a 10-year experience from a UK pediatric surgical center. J Pediatr Surg. 2007;42:1251–4.CrossRefGoogle Scholar
  20. 20.
    Geyer M, Kubba H, Hartley B. Experiences of tracheocutaneous fistula closure in children: how we do it. Clin Otolaryngol. 2008;33:59–369.Google Scholar
  21. 21.
    Tasca RA, Clarke RW. Tracheocutaneous fistula following paediatric tracheostomy – a 14-year experience at Alder Hey children’s hospital. Int J Pediatr Otorhinolaryngol. 2010;74(6):711–2.CrossRefGoogle Scholar
  22. 22.
    Osborn AJ, de Alarcón A, Hart CK, Cotton RT, Rutter MJ. Tracheocutaneous fistula closure in the pediatric population: should secondary closure be the standard of care? Otolaryngol Head Neck Surg. 2013;149(5):766–71.CrossRefGoogle Scholar
  23. 23.
    Wine TM, Simons JP, Mehta DK. Comparison of 2 techniques of tracheocutaneous fistula closure: analysis of outcomes and health care use. JAMA Otolaryngol Head Neck Surg. 2014;140(3):237–42.CrossRefGoogle Scholar
  24. 24.
    Haynes JH, Bagwell CE, Salzberg AM. Management of persistent pediatric tracheostomal fistulas. J Pediatr Surg. 1995;30:566–7.CrossRefGoogle Scholar
  25. 25.
    Antόn-Pacheco JL, Villafruela M, Lόpez M, Gracia G, Luna C, Martínez A. Surgical management of severe suprastomal cricotracheal collapse complicating pediatric tracheostomy. Int J Pediatr Otorhinolaryngol. 2008;72:179–83.CrossRefGoogle Scholar
  26. 26.
    Schroeder JW Jr, Greene RM, Holinger LD. Primary closure of persistent tracheocutaneous fistula in pediatric patients. J Pediatr Surg. 2008;30:1786–90.CrossRefGoogle Scholar
  27. 27.
    Gallagher TQ, Hartnick CJ. Tracheocutaneous fistula closure. Adv Otorhinolaryngol. 2012;73:76–9.PubMedGoogle Scholar
  28. 28.
    Wisniewski BL, Jensen EL, Prager JD, et al. Pediatric tracheocutaneous fistula closure following tracheostomy decannulation. Int J Pediatr Otorhinolaryngol. 2019;125:122–7.CrossRefGoogle Scholar
  29. 29.
    Sautter NB, Krakovitz PR, Solares CA, Koltai PJ. Closure of persistent tracheocutaneous “starplasty” tracheostomy in children. Int J Pediatr Otorhinolaryngol. 2006;70:99–105.CrossRefGoogle Scholar
  30. 30.
    Greve J, Schuler PJ, Hoffmann TK. Evaluation of customized prosthesis for irregularly formed tracheostoma after laryngectomy. Ann Otol Rhinol Laryngol. 2016;125(2):145–50.CrossRefGoogle Scholar
  31. 31.
    Doescher J, Scheckenbach K, Angerstein W, Veit JA, Laban S, Thierauf J, Theodoraki MN, Greve J, Schuler PJ, Hoffmann TK. Evaluation of customized prosthesis for irregularly formed tracheostoma after laryngectomy. Ann Otol Rhinol Laryngol. 2016;125(2):145–50.CrossRefGoogle Scholar
  32. 32.
    Erovic BM, Lercher P. Manual of head and neck reconstruction using regional and free flaps. Wien: Springer; 2015. p. 103–20.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
  2. 2.Institute of Head and Neck Diseases, Evangelical HospitalViennaAustria

Personalised recommendations