Closure of permanent tracheostomy in patients with sleep apnea: a comparison of two techniques.

A "permanent" skin-lined tracheostomy is used for patients with severe obstructive sleep apnea syndrome who fall, refuse, or can't tolerate continuous positive airway pressure. Closure of the stoma may be performed if the apnea has been controlled by surgeries that enlarge and stabilize the upper airway, if adequate weight loss occurs, or if the patient decides to accept continuous positive airway pressure. Two different closure techniques are compared. Sixty-nine three-layer closures were performed in 66 patients from 1980 to 1990. Postoperative complications, including stridor, subcutaneous emphysema, pneumomediastinum, tracheal granuloma, hematoma, and respiratory arrest, occurred in 30% of patients, and three required reopening of their tracheostomy sites. After 1990 a simple deepithelialization technique was used in 10 patients without any major complications. This technique is simpler and quicker and can be performed with the patient under local anesthesia.