Ann Thorac Surg 2006;82:1545-1546
© 2006 The Society of Thoracic Surgeons
How To Do It
Self-Made Tracheal Stomal Stent Using a Tracheal T-Tube
Samuel Garcia, MD,
Jose Maria Gimferrer, MD,
Manoli Iglesias, MD,
Miguel Catalan, MD,
Elisabeth Martinez, MD,
Paolo Macchiarini, MD, PhD*
Department of General Thoracic Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
Accepted for publication October 6, 2005.
* Address correspondence to Dr Macchiarini, Department of General Thoracic Surgery, Hospital Clinic of Barcelona, University of Barcelona, Villaroel 170, Barcelona, 08036 Spain (Email: pmacchiarini{at}clinic.ub.es).
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Abstract
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Adapting a silicone tracheal safe T-tube is a simple method to guarantee upper airway permeability. Its making and availability ease offers a cheap and valid option to avoid the complications of the tracheostomy tube.
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Introduction
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Tracheal stomal stents or tracheostomy buttons are used to maintain stomal patency while providing an access for suctioning and replacement of a tracheostomy tube for emergency ventilation [1]. They are widely used in patients with sleep apnea, vocal cord adduction paralysis, laryngeal insufficiency, or after T-tube removal until stability of the airway is achieved, or the patient accepts withdrawal of airway stenting or tubing [2, 3]. Tracheal stomal stents offer several advantages (eg, foreign bodies are not projected into the trachea; flexibility; the stents are clinically well tolerated and their smooth surface avoid secretions adhesion). The closure plug on the button allows normal respiration, and provides means for verbal communication and ease of swallowing. Although several designs of stomal stents are commercially available [4], we describe a technique to adapt a silicone tracheal T-tube by converting it into a tracheal stomal stent.
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Technique
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The original stent is the silicone Montgomery tracheal T-tube, which has an intratracheal and extraluminal portion. The last one made has ridges and grooves that allow fixation of the stent by attaching a ring washer. These grooves also allow a speaking valve to be attached when indicated and permit the T-tube to be cut with scissors to the desired length. It is supplied with a plug, which is inserted with a slight twist, and remains in place by friction even with forceful toughing [5]. The self-made tracheostoma is the intratracheal portion, which is carefully cut with scissors to produce two oval flaps vertically disposed so that only the border area to the extraluminal portion is left (Fig 1). One should avoid cutting the flaps either too small to prevent the anterior displacement of the stent or too big to prevent the flaps from irritating the tracheal anterior wall. A general rule is to obtain a flap diameter at least 3 mm larger than the stoma diameter. With this simple manipulation, one can have the stent ready to be inserted. The insertion is made with the patient in the supine position with the neck slightly hyperextended. The stoma is then visualized and the intraluminal portion of the stoma is inserted into the trachea. The projecting edge of the inner stent must be placed against the anterior tracheal wall. Finally the ring washer is applied to the groove adjacent to the skin surface. If there is a short distance between the anterior tracheal wall and surface of the anterior cervical skin, two ring washers can be applied to maintain the stability. If necessary, the plug can be inserted.
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Fig 1. The intratracheal portion of the original Montgomery T-tube is cut to obtain two oval flaps vertically disposed while keeping the border area to the extraluminal portion.
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Comment
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The present technique is a valid option to maintain the upper airway permeability for a long period of time in patients with tracheostomy. The stent is easy to make, and it is well tolerated and safe. In our experience the stent has an excellent history of acceptance and compliance especially in patients holding T-tubes for a long period of time who are used to having this foreign body within the airway, and who have also refused an unstented airway or another type of stent. In such occasions, the same previously holded T-tube may be remodelled to a stoma and used to safeguard the airway. Indeed it can be used for all those circumstances that need maintaining the stoma open for any reason.
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References
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- Hess DR. Tracheostomy tubes and related appliances Respir Care 2005;50:497-510.[Medline]
- Strauss M. Use of modified silicone tracheal cannula for obstructive sleep apnea Laryngoscope 1990;100:152-154.[Medline]
- Lavelle WG, Montgomery WW, Jacobs Jr EE. Silicone tracheal cannulaupdate. Ann Otol Rhinol Laryngol 1987;96:446-448.[Medline]
- Wilson DL. Tracheal appliancesIn: Grillo HC, editor. Surgery of the trachea and bronchi. Hamilton, London, UK: BC Decker Inc; 2004. pp. 735-748.
- Montgomery WW, Montgomery SK. Manual for use of Montgomery laryngeal, tracheal, and esophageal prostheses: update 1990 Ann Otol Rhinol Laryngol Suppl 1990;150:2-28.[Medline]
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Abstract
Introduction
