Airway Management Following Head and Neck Microvascular Reconstruction: When is a Tracheostomy Necessary?
Pao-Jen Kuo, Pi‐Chieh Lin, Ching-Hua Hsieh Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital Chang Gung University and College of Medicine, Kaohsiung, TaiwanCorrespondence: Ching-Hua Hsieh, Email m93chinghua@gmail.comAbstract: Head and neck free flap reconstruction presents compl...
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Dove Medical Press
2025-08-01
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| Series: | Risk Management and Healthcare Policy |
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| Online Access: | https://www.dovepress.com/airway-management-following-head-and-neck-microvascular-reconstruction-peer-reviewed-fulltext-article-RMHP |
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| author | Kuo PJ Lin P Hsieh CH |
| author_facet | Kuo PJ Lin P Hsieh CH |
| author_sort | Kuo PJ |
| collection | DOAJ |
| description | Pao-Jen Kuo, Pi‐Chieh Lin, Ching-Hua Hsieh Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital Chang Gung University and College of Medicine, Kaohsiung, TaiwanCorrespondence: Ching-Hua Hsieh, Email m93chinghua@gmail.comAbstract: Head and neck free flap reconstruction presents complex airway challenges due to postoperative swelling, bleeding, and anatomical distortion that can jeopardize breathing. Many centers once performed routine prophylactic tracheostomy for major cases, yet modern evidence favors a selective strategy. Avoiding an unnecessary tracheostomy when feasible can reduce morbidity, shorten hospital stay, accelerate return to oral intake, and lower cost. Contemporary practice relies on careful intraoperative assessment. Low-risk patients can be extubated immediately or after brief observation, whereas high-risk features—extensive tongue or base of tongue resection, bilateral neck dissection, bulky flap, or marked edema—mandate a tracheostomy to avert obstruction. There is new update to TRACHY (an acronym that represents Tumor extent, Reconstruction type, Airway anatomy, Coexisting conditions, History of prior treatment, and bilateral neck dissection “lateralitY”) scoring systems and risk stratification tools, which assign risk points to support decisions. Once a tracheostomy is placed, decannulation proceeds when airway patency is secure, the patient is alert with a strong cough, the surgical site is stable, swallowing is safe or alternative feeding is available, capping trials are successful, and the multidisciplinary team agrees. A tailored approach therefore balances airway safety with the benefits of tracheostomy avoidance, optimizing outcomes for patients undergoing complex head and neck reconstruction.Keywords: airway management, tracheostomy, free flap reconstruction, head and neck surgery, decannulation criteria |
| format | Article |
| id | doaj-art-0f84d1985d2c4ef795574410152e8bc4 |
| institution | Kabale University |
| issn | 1179-1594 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Risk Management and Healthcare Policy |
| spelling | doaj-art-0f84d1985d2c4ef795574410152e8bc42025-08-20T03:44:01ZengDove Medical PressRisk Management and Healthcare Policy1179-15942025-08-01Volume 18Issue 125512563105475Airway Management Following Head and Neck Microvascular Reconstruction: When is a Tracheostomy Necessary?Kuo PJ0Lin P1Hsieh CH2Plastic SurgeryPlastic surgeryDepartment of Plastic SurgeryPao-Jen Kuo, Pi‐Chieh Lin, Ching-Hua Hsieh Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital Chang Gung University and College of Medicine, Kaohsiung, TaiwanCorrespondence: Ching-Hua Hsieh, Email m93chinghua@gmail.comAbstract: Head and neck free flap reconstruction presents complex airway challenges due to postoperative swelling, bleeding, and anatomical distortion that can jeopardize breathing. Many centers once performed routine prophylactic tracheostomy for major cases, yet modern evidence favors a selective strategy. Avoiding an unnecessary tracheostomy when feasible can reduce morbidity, shorten hospital stay, accelerate return to oral intake, and lower cost. Contemporary practice relies on careful intraoperative assessment. Low-risk patients can be extubated immediately or after brief observation, whereas high-risk features—extensive tongue or base of tongue resection, bilateral neck dissection, bulky flap, or marked edema—mandate a tracheostomy to avert obstruction. There is new update to TRACHY (an acronym that represents Tumor extent, Reconstruction type, Airway anatomy, Coexisting conditions, History of prior treatment, and bilateral neck dissection “lateralitY”) scoring systems and risk stratification tools, which assign risk points to support decisions. Once a tracheostomy is placed, decannulation proceeds when airway patency is secure, the patient is alert with a strong cough, the surgical site is stable, swallowing is safe or alternative feeding is available, capping trials are successful, and the multidisciplinary team agrees. A tailored approach therefore balances airway safety with the benefits of tracheostomy avoidance, optimizing outcomes for patients undergoing complex head and neck reconstruction.Keywords: airway management, tracheostomy, free flap reconstruction, head and neck surgery, decannulation criteriahttps://www.dovepress.com/airway-management-following-head-and-neck-microvascular-reconstruction-peer-reviewed-fulltext-article-RMHPAirway managementTracheostomyFree flap reconstructionHead and neck surgeryDecannulation criteria |
| spellingShingle | Kuo PJ Lin P Hsieh CH Airway Management Following Head and Neck Microvascular Reconstruction: When is a Tracheostomy Necessary? Risk Management and Healthcare Policy Airway management Tracheostomy Free flap reconstruction Head and neck surgery Decannulation criteria |
| title | Airway Management Following Head and Neck Microvascular Reconstruction: When is a Tracheostomy Necessary? |
| title_full | Airway Management Following Head and Neck Microvascular Reconstruction: When is a Tracheostomy Necessary? |
| title_fullStr | Airway Management Following Head and Neck Microvascular Reconstruction: When is a Tracheostomy Necessary? |
| title_full_unstemmed | Airway Management Following Head and Neck Microvascular Reconstruction: When is a Tracheostomy Necessary? |
| title_short | Airway Management Following Head and Neck Microvascular Reconstruction: When is a Tracheostomy Necessary? |
| title_sort | airway management following head and neck microvascular reconstruction when is a tracheostomy necessary |
| topic | Airway management Tracheostomy Free flap reconstruction Head and neck surgery Decannulation criteria |
| url | https://www.dovepress.com/airway-management-following-head-and-neck-microvascular-reconstruction-peer-reviewed-fulltext-article-RMHP |
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