The patient with tracheostomy has to lead life for a while with utmost care of wound & tube and after a certain period most of the cases this alternate pathway required to be closed and reestablished the normal airway and this process of closure of the wound is called decannulation. Most of the decannulation can be done normally by simple strapping of the wound from side to side, prior to that it is to be seen wheather the patient can pass overnight with sound sleep either corking or sealing of the lumen of the tracheostomy tube. But in some cases this ordinary (Medical decannulation3) process can not possible and need some surgical measure. Where even after extubation the wound margins are not apposed together due to some reasons such as scarring of the wound, inversion of the wound margin inside the lumen of the trachea, change of pattern of epithelial lining around the lumen of the tracheal opening, even formation of granulation tissue around the tracheal opening and consequently loss of elasticity of the surrounding skin in long standing case of tracheostomy wound other than repeated lower respiratory tract infection.

Figure 3: Closure of teacheostomy wound by stitching
Figure 4: Dressing of wound after closure

This poor male patient aged 17 years has come to the ENT department of Moulana Bhasani Medical College Hospital with a history of more than five years tracheostomy wound with tube in situ with unhealthy skin around the tracheostomy tube with some granulation tissue. His tracheostomy tube was tried to extubate after subsidence of infection following repeated cleaning and dressing for about two weeks under antibiotic coverage. When the patient can pass over night with sound sleep after closing of the lumen of the tube then his wound was decided to closed. There was an elliptical stoma and the margin of the wound was partly inverted inside the lumen and change of pattern of the surrounding skin of the stoma with poor elasticity and could not bring the margin together from side to side by strapping for few days.

After that the surgical interference was done such as eversion of the margin of the skin & removal of granulation tissue, trimming of the margin of the skin and separation of the skin from the underlying subcutaneous tissue to some extent then apposition of the skin margin vertically together by 2/0 silk from above downwards with interrupted stitches and dressed aseptically with pressure bandage which changed after 48 hours. The stitches removed after 7 days. And the patient was discharged with advice to attend ENT out patient department after 2-3 weeks or if any difficulty arises at any time for follow up.

Conclusion
During decannulation, one has to see whether the purpose of tracheostomy has served or not and also need to assess the way how to close the wound for reestablishment of normal airway for respiration without any disturbance of breathing.

References
  • 1.  Tracheostomy care handbook, change the outcome.
  • 2.  More on Decanulation Decanulation, Michael Rothschild, MD, Director, Pediatric Otolaryngology Mount Sinai Medical Center file:/H/Decanulation.htm
  • 3.  Trachostomy Ward decanulation, Infromations for families, Great Ormond Street Hospital for Children NHS Trust www.childrenfirst.nhs.UK
  • 4.  Decannulation. Principles from diseases of Ear. Nose & Throat, Third Edition By P.L. Dhingra. Published by Elsvier & division of Reed elsevier Indea
         Private Limited.
  • 5.  Complications of tracheastomy from Ballenger's Otorhinolarynoglogy Head & Neck Surgery. 16th Edition, By James B Snow Jr. MD. Johon Jacob
         Ballenger MD. Published by IABN-1 55009-1972, Printed in spanin page 1157-59.
  • 6.  Decannulation from Steell & Marans Head & Neck Surgery 14th Edition, By-J.C. Watkinson, M.N.Gaze, J.A.Wilson. Published By Gray Publishing.
          Turn Bridge Wells kent.Printed & bound in India.
  • 7.  After care of tracheastomy from lecture notes on diseases of the Ear, Nose of Throat, By P.D. Bull. 6th Edition. Published by Blackwell Scientific
         publications. Oxfort London Edinburgh, Boston Plo Alto Melborne.
  • 8.  Difficulty with Decnnulation from Scott_Brown's Otolerynology - 6th Edition Volume -5-5/7/16 Edited by John Hibbert. Butter Warth-Heinemann (B.H)
         Internationl Editions. K.M.Varghese Company Hind Rajsthan, Building. Dader, Mombai, 400 014.
  • 9.  Decanulation -Fundamentals of Ear, Nose & Throat with Head-Neck Surgery By Dr. Shyamal Kumar De Published by the New Book Stall (nbs)
         Calculttla. 7th Edition Page-475



Dr. Captain (Rtd.) Sitara Begum, Bir Protik
"The Heroines of 1971"
 

 
Captain Sitara Begum is the women who hold the title `Bir Pratik' in 1995 for her heroic contribution in our liberation war. Bir Pratik Sitara Begum was born in Kolkata in 1945. Her father Md. Israil was a lawyer. After passing MBBS and completing her internee from Dhaka Medical College Hospital, she joined the arm force in 1970. She was a lieutenant till the liberation war was started in 1971. She was promoted as a `Captain' by the order of General Ataul Gain Osmani. Her elder brother was a freedom fighter. Dr. Sitara Begum reached to Meghalaya of India in August 1971 and after 2-3 weeks she joined Bangladesh hospital in Meghalkaya where wounded freedom fighters were given medical treatments. She was under sector two (2). The hospital was made of  

Dr. Captain (Rtd.) Sitara Begum, Bir Protik was awarded for her gracious contribution in the liberation war 1971 by Physicians for Peace Society, Bangladesh & Orion Laboratories Ltd.

  bamboo which didn't look like a hospital from outside. Inside the hospital there were 400 beds & there worked more than 400 final year students under the direction of Captain Sitara Begum. There were many Bangladeshi doctors from abroad for the treatment of the wounded freedom fighters, and there were many volunteers from army assisting them. The doctors had to go to Agartala, Udaypur for medicines. The operation theater was a room covered with plastic cloth; the floor was also covered with plastic cloth. Indian armies also used to come to the hospital for treatment. Without Dr. Sitara Begum's devotion and excellent co-ordination it wouldn't be possible to give medical treatment to so many wounded soldiers with such insufficient facilities.
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  Volume 32, Issue 2, May 2009
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