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To the Editor.—I was interested in the article on tracheotomy tube replacement by Lewy in the May Archives (1982;108:327) and the subsequent letter by Goodman (1983;109:277).
In recent years, we have routinely used a flap tracheotomy, wherein a flap of tracheal wall based inferiorly and including approximately two rings of trachea is sutured to the lower edge of the skin incision, regardless of whether the skin incision is horizontal or vertical. This creates a much safer situation than a standard tracheotomy. If the tracheotomy tube is coughed out or falls out, the opening into the trachea will usually stay open without any tube for an appreciable period. Replacement of the tube is simple and can be done by anyone without any instruments and without light.
I believe that the method of tracheotomy using a flap is an important advance in the technique of tracheotomy and should be adopted by
OLSON NR. Tracheotomy Tube Replacement. Arch Otolaryngol. 1983;109(9):634. doi:10.1001/archotol.1983.00800230070019
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