Using Pericardium Allograft in Closing Tracheal Fistula after Removing Tracheotomy Tube

Tracheotomy is used to keep and control airways open and protect them in head and neck operations.1-3 Tracheotomy is opening a direct airway through an incision in the trachea observed as a stoma in the lower throat and it is usually performed in serious head and neck traumas, tumors, bleedings and cases that intubation with endotracheal tube is not possible. This method has several advantages for the patient, including suction of lung secretions, decreasing respiratory dead space and application of positive pressure on the lungs. Also tracheotomy prevents aspiration of mouth and stomach secretions in unconscious or paralyzed patients. The location of tracheotomy incision is trachea fourth cartilage ring under cricoids. Tracheotomy tube is inserted through a small incision on the neck between two cartilage rings into the trachea. The resulting open wound is prone to infections.4,5 To perform tracheotomy first a cuffed tube and after about 1.5 months and non-cuffed tube is used. Cuff is a balloon like addition on the tracheotomy tube that enters the trachea and can be filled or emptied through a valve by syringes outside the trachea. Cuff prevents choking due to being unable to swallow food or secretions in fully or semi unconscious patients. After treatment is complete and ensuring that the upper tracheotomy tube airways are open, the tube is removed slowly and step by step from the patient’s trachea. The wound from tracheotomy closes on its own within 1 to 2 months but may have the following side effects: Skin dimpling, neck deformity, obstruction in respiratory tract, respiratory stridor, vocal complications, lung and airway infections. neck deformity is repaired by a separate operation with platysma flop and zplasty.4,5 Our suggested method is using pericardium allograft or facial allograft in repairing the trachea trauma.4,5 Patients with enough tissue to cover the lesion, their own tissues are used as autograft. But the main problem is for patients without sufficient tissues. One of the best options is using allograft tissues from another person. In most advance medical centers, allograft tissues from brain dead individuals or corpses are used. Bone, cartilage, tendon and skin donors must be free from diseases. Therefore it is necessary to screen donors to prevent future medical complications. Allograft is supplied from tissue banks. Countries such as the Netherlands have a tissue bank that supplies even the whole European Union.6 In transplant of organs such as kidney or cornea, the donated organ must be used immediately but allograft transplant can 1. Department of Plastic Surgery, Zanajan University of Medical Sciences, Zanjan, Iran; 2. Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran