Is it okay if a tracheostomy (trach) stoma remains open years after decannulation?

Management of Persistent Tracheostomy Stoma After Decannulation

A persistent tracheostomy stoma years after decannulation is not normal and formal surgical closure is necessary. 1

Normal Healing Process

• In most patients, the tracheostomy stoma closes spontaneously within hours to days after decannulation 1
• The median time to initial stoma closure is approximately 5 days, with complete healing of the stoma site taking around 16 days 2
• Spontaneous closure time correlates with the duration of cannulation - longer cannulation periods typically result in longer healing times 3

Factors Affecting Stoma Closure

• Factors that may delay stoma closure include:
  • Increasing age 2
  • Diabetes 2
  • Steroid use 2
  • Larger initial stoma size 2
  • Prolonged tracheostomy tube presence 4
  • Duration of cannulation (strongest correlation) 3

Evaluation of Persistent Stoma

• Endoscopic evaluation is essential for patients with persistent stoma to:
  • Rule out anatomic or functional airway obstruction 1
  • Identify granulation tissue that may be present 5
  • Assess for tracheomalacia or stenosis that may have developed 6
  • Evaluate for suprastomal collapse 1

Management Approach

• For stomas that persist beyond the expected healing time (>3 weeks):
  • Formal surgical closure is necessary rather than continued observation 1
  • Surgical techniques may include muscle flaps (such as sternohyoid muscle) and skin flaps to:
    • Seal the stoma effectively 4
    • Provide soft tissue between the trachea and skin 4
    • Achieve satisfactory cosmetic results 4

Complications of Persistent Stoma

• A persistent open stoma can lead to:
  • Negative impact on respiration 3
  • Hygiene issues 3
  • Cosmetic concerns 3
  • Social life limitations 3
  • Increased risk of respiratory infections due to direct airway exposure 1

Prevention Strategies

• Proper tracheostomy technique initially may reduce risk of persistent stoma:
  • Creating a formal skin-to-trachea stoma for tracheostomies likely to be in place for extended periods 6
  • Minimizing trauma to tracheal cartilage during the initial procedure 6
  • Careful selection of appropriate tube size, length, and curvature 1

Key Considerations Before Decannulation

• Endoscopic evaluation before decannulation can identify and address issues that might affect stoma closure 5
• The American Thoracic Society recommends ensuring that:
  • The original need for tracheostomy is no longer present 5
  • The patient can maintain a safe and adequate airway independently 5

In conclusion, while most tracheostomy stomas close spontaneously within days after decannulation, a stoma that remains open for years is abnormal and requires formal surgical closure to prevent complications and improve quality of life.