Better tracheostomy technique- Bjork flap or tracheal window?

Upper airway obstruction, prolonged intubation, and the need for a pulmonary toilet are commonly treated by tracheostomy. Tracheostomy is a commonly performed surgical procedure that allows patients to breathe while bypassing the mouth, nose, and throat. A recent study by Maeve M. Kennedy and team talks about various factors that influence the choice of surgical procedure Bjork flap or tracheal window.

The objective of the study was to evaluate the factors that influence the surgical decision whether tracheal window or Bjork flap and its benefits depending on the patient and tracheostomy circumstances.

The researchers conducted a retrospective review of all patients who had undergone tracheostomies from January 2015 to December 2019 at a tertiary care medical center. All patients who had undergone tracheostomy with either a Bjork flap or a window were chosen. Charts were reviewed for demographics, comorbidities, indication for tracheostomy, operative details, and complications.

The researchers evaluated a total of 217 tracheostomies, of which 104 (47.9%) had a Bjork flap and 113 (52.1%) had a window. Bjork flap was significantly more likely to be performed in patients with a higher average body mass index (p = 0.05), requiring ventilatory support (p = 0.0001), or had a stroke (p = 0.0140). A window was used significantly more in patients with prior neck dissection (p = 0.0110) or neck radiation (p < 0.0001). No significant difference was observed for post-op bleeding, returning to the operating room, or days to decannulation. In all tracheostomies, thrombocytopenia was found to significantly correlate with post-op bleeding (p = 0.0006), while blood thinner use did not.

The researchers concluded that "Bjork flaps were more likely to be performed in those with a history of prolonged mechanical ventilation and elevated body mass index. Windows were performed more frequently in patients with a head and neck cancer history. Future prospective studies are needed to compare the outcomes of these techniques and their impacts on the trachea long term."

For further information:

Maeve M. Kennedy, Yassmeen Abdel-Aty, David G. Lott "Comparing tracheostomy techniques: Bjork flap vs. tracheal window" American Journal of Otolaryngology–Head and Neck Medicine and Surgery 42 (2021) 103030.