Abstract
Objectives: Tracheal necrosis is a rare but well-known complication of prolonged ventilation with a cuffed endotracheal tube. We report a case of iatrogenic tracheal necrosis from percutaneous tracheostomy (PT) leading to a critical airway and share our experience of managing this complication. Methods: Case report with literature review. Results: A 67 year old Caucasian man underwent uneventful PT. He developed stridor after successful decannulation. The examination revelaed soft tissue prolapse into the tracheal lumen and 60% tracheal lumen narrowing. Exploration of the tracheostomy site revealed necrosis of anterolateral wall of the trachea. The defect was regarded too large to be amenable to simple reconstruction. A tracheostomy tube was inserted to secure the airway and allow scar contracture to take place. The tube was downsized gradually allowing eventual successful decannulation. Conclusion: Injury to the tracheal cartilage following PT can lead to localized infection, ischaemia and necrosis resulting in a compromised airway.
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