Tracheostomy Wound Research Articles

Сравнение методик пункционно-дилатационной трахеостомии Фрова и Григгс у пациентов с избыточной массой тела и ожирением: рандомизированное контролируемое исследование

INTRODUCTION: Tracheostomy is one of the most frequently performed operations in intensive care patients. This is due to the fact that in the population of intensive care patients, puncture tracheostomy has a number of advantages compared to surgical tracheostomy (ST). This determines the urgency of finding ways to reduce the risk of perioperative complications during puncture tracheostomy in intensive care patients, especially in overweight and obese patients. OBJECTIVE: To study the advantages and limitations of puncture dilation tracheostomy (PDT) performed using the Frova method under ultrasound control in intensive care patients with overweight and obesity, in comparison with the Griggs PDT method under fibrobronchoscopic (FBS) control. MATERIALS AND METHODS: The presented prospective study was conducted in the departments of anesthesiology and intensive care of the A.I. Burnasyan Federal Medical Biophysical Center FMBA from 2017 to 2021, which included 92 overweight and obese patients whose body mass index (BMI) was more than 25 kg/m2 and required tracheostomy. Two groups were identified: group (n = 48) — Frova tracheostomy under ultrasound control, group (n = 44) — Griggs tracheostomy under FBS control. RESUITS: Performing PDT using the Frova technique under ultrasound control is feasible and safe in intensive care patients with overweight and obesity, whereas with grade 3 obesity with a BMI of more than 41 kg/m2 and/or with a thickness of pretracheal soft tissues of more than 40 mm, PDT using the Frova technique should be abandoned and should be considered as absolute contraindications for performing PDT using the Frova method under ultrasound control. CONCLUSIONS: PDT using the Frova method under ultrasound control, when compared with the Griggs method with FBS control, can significantly reduce the incidence of intraoperative desaturation, arterial hypotension, intraoperative severe hemorrhagic complications, postoperative soft tissue infection around a tracheostomy wound.

Novel Method for Sealing Tracheostomies Immediately after Decannulation-An Acute Clinical Feasibility Study.

Tracheostomy decannulation leaves an iatrogenic passage in the upper airways. Inadequate sealing leads to pulmonary dysfunction and reduced voice quality. This study aimed to investigate the feasibility and impact of intratracheal tracheostomy sealing on laryngeal airflow and voice quality immediately after decannulation (ClinicalTrials.gov: NCT06138093). Fifteen adult, tracheostomized, intensive care unit patients were included from our hospital. A temporary, silicone-based sealing disc was inserted in the tracheostomy wound immediately after decannulation. Spirometry with measurement of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and peak expiratory flow (PEF) were performed as measures of airway flow. Voice recordings were assessed using an equal appearing interval scale from 1 to 5. Median FVC, FEV1, PEF, and voice quality score with interquartile range (IQR) was 883 (510-1910) vs. 1260 (1005-1723) mL (p < 0.001), 790 (465-1255) vs. 870 (617-1297) mL (p < 0.001), 103 (55-211) vs. 107 (62-173) mL (p = 0.720), and 2 (1-2.5) vs. 4 (3-5) points (p < 0.001), respectively, with open tracheostomy vs. after sealing the tracheostomy with the intratracheal sealing disc. This feasibility study showed that tracheostomy sealing with the intratracheal disc was safe and led to immediate improvements in FVC, FEV1, and voice quality.

A Clinical Study on Microbiological Profile in Tracheostomy Wounds.

Tracheostomy is a surgical procedure in an emergency setting to relieve the upper airway obstruction by creating an opening in the anterior part of trachea. It can also be done electively to wean off from a ventilator, during an elective surgery and clearance of pulmonary secretions. This study was a retrospective analysis of microbiological profile, antibiotic sensitivity & resistance pattern in patients with a tracheostomized wound. A retrospective review of the microbiological profiles of all adult patients who underwent a tracheostomy was conducted between May 2022 and May 2023 at our hospital. Based on the tracheostomy indications, patients were allocated under obstructed and non-obstructed group. Any patient with at least one positive sample was followed up quarterly for a year. The first culture result obtained was recorded at least one month following the last antibiotic dose in each quarter. Out of the 65 tracheal aspirate results obtained from 58 patients (mean age, 57.5 ± 16.48 years), the most common procedure and indications were surgical tracheostomy (72.4%) and non-obstructed causes (74.1%), respectively. Moreover, 47.7% of the culture results indicated Pseudomonas aeruginosa, which showed significantly different proportions across the quarters (p = 0.006). Among obstructed patients, P. aeruginosa was the most common (35%), followed by methicillin-resistant Staphylococcus aureus (MRSA; 23.5%). The colonization was predominantly by gram negative bacteria Acinetobacter species, P. aeruginosa & Klebsiella pneumoniae and fungal species like Candida albicans followed by Aspergillus niger and non-Albicans candida.

Tracheostomy wound myiasis in a patient with hypoxic encephalopathy

•Tracheostomy wound myiasis is rarely observed in unconscious and immobile patients.•Maggots in the vicinity of the tracheostomy site should be closely monitored.•Controlling myiasis in hospitals requires fly control and patient fluid management.

Postoperative photography reduces incorrect wound breakdown diagnoses in tracheostomy

PurposeThis study was performed to investigate the effect of including immediate postoperative photographs of a tracheostomy site on diagnoses (correct and incorrect) of wound breakdown in a pediatric patient population. Materials and methodsChart review was performed of all patients from 2017 to 2019 who underwent a tracheostomy. Within this time span, the practice of the hospital changed such that postoperative photography was taken of the tracheostomy site. There were no changes in in-service training protocols over this time. Wound breakdown diagnoses were examined prior to and after the intervention. Diagnoses were categorized by severity according to the National Pressure Ulcer Advisory Board. Diagnoses were then divided into correct or incorrect based on examination by physician teams at the time of the diagnosis. ResultsForty five patients underwent a tracheostomy during the study period. When comparing the two groups, there was a reduction in all wound breakdown diagnosis by 91 %, and those diagnoses which were entered into the chart after the photos were verified as correct. ConclusionsWithout appropriate context as to the nature of tracheostomy wounds, many providers may incorrectly grade a healthy wound as wound degradation, which can affect care, reimbursement, and hospital ratings. We present our findings of placing an intraoperative wound photo in the patient's electronic medical record as a reference should wound concerns arise. We believe this is an easy action which can enhance patient care, decrease unnecessary work, and provide an accurate documentation of tracheostomy care pathways and results.

"Tracheostomy healing time after decannulation": can we improve it?

Dear Editor, We read with great interest the article “Tracheostomy healing time after decannulation” by Christiansen et al. The authors aimed to determine the tracheostomy wound healing time after decannulation...

Tracheostomy healing time after decannulation.

BackgroundProlonged healing of tracheostomy after decannulation has a negative impact on respiration, hygiene, cosmetics, and social life. Even so, evidence-based observations of tracheostoma healing time are lacking. Therefore, the aim of this study was to determine tracheostomy wound healing time after decannulation.MethodsIn this prospective observational cohort study, we included 30 subjects undergoing decannulation following prolonged mechanical ventilation via tracheostomy. Our primary endpoint was tracheostomy healing time defined as time from decannulation to airtight healing. To identify any factors related to healing time, we included information about patient demographics, comorbidities, tracheostomy method, tube size, and intubation time. All subjects were observed daily until their tracheostomy wound had healed.ResultsThe median tracheostomy healing time was 6.5 (1-22) days. The duration of tracheal cannulation was the only factor significantly correlated with prolonged healing (p=0.03). Four patients were subjected to recannulation shortly after decannulation due to hypercapnia, respiratory failure, secretion accumulation, or self-decannulation. All wounds achieved complete spontaneous airtight closure.ConclusionsDuration of spontaneous tracheostomy closure after decannulation was 1-22 days, and closure time correlated with duration of cannulation.

Feasibility of Percutaneous Dilatational Tracheotomy in Head and Neck Cancer Surgery: A Preliminary Study

ObjectivePercutaneous dilational tracheostomy (PDT) is a technique that can place a tracheostomy tube safely without visually identifying the trachea. We evaluated its feasibility during head and neck cancer surgery.Summary of background dataPDT has many advantages, such as less bleeding, easier technique, and shorter procedural time.MethodsTwelve patients who underwent PDT during head and neck cancer surgery from September 2016 to March 2018 were enrolled, and their medical records were reviewed retrospectively. Medical records of another 12 patients who underwent conventional tracheostomy during head and neck cancer surgery were analyzed. PDT was performed using a Ciaglia Percutaneous Tracheostomy Set. The tracheostomy point was determined by palpation without the guidance of bronchoscopy or ultrasonography. Blood loss, procedural time, communication between the cervical wound and tracheostomy wound, and complications were compared between the PDT group and the conventional group.ResultsThe PDT group had less blood loss, a shorter procedural time, and a lower incidence of communication between the cervical and tracheostomy wound. There was 1 case of conversion to conventional tracheostomy due to wrong tracheal penetration in the PDT group.ConclusionsPDT is safe and effective as an adjunctive procedure during head and neck cancer surgery.

Myiasis of Peristomal Sinuses Around Tracheostomy Wound: Case Report of 2 Cases.

"Myiasis" is considered in Hindu mythology as "God's punishment for sinners". Literature abounds with reports of myiasis affecting the nasal cavity, ear, non healing ulcers, exophytic malignant growth and cutaneous tissue. But case report of myiasis of the tracheostomy wound is relatively rare and that also peristomally is seen first time. We are reporting two cases whose tracheostomy was done, one for laryngeal cancer and other for laryngocoele. We are discussing the need for the proper care of tracheostomy wound myiasis because the site of such an infestation is close to vital organs in the neck and avoiding complications.

Use of simulation for training family caregivers of patients receiving radiation therapy.

TPS12129 Background: Positive treatment outcomes and avoidance of complications are dependent to a large extent on the care provided by family members. However, family caregivers report feeling unprepared to assume the multiple, complex tasks of caregiving, including tracheostomy care, tube feedings, wound and colostomy care, pain management, and emotional support. Despite being a critical extension of the oncology healthcare team, training of caregivers to manage symptoms, deal with communication issues with the care recipients, and take care of their own physical and emotional health as caregivers, is not integrated into clinical practice. The purpose of this clinical trial is to measure the effect of a psychoeducational caregiver intervention that incorporates simulation techniques focused on skill development to improve caregiver and patient outcomes. Simulation, commonly used in training healthcare professionals, is a form of experiential learning that creates events or situations to mimic clinical situations. Use of simulation for skills training in family caregivers of patients with cancer is rarely studied. Methods: This two-group, randomized clinical trial, which opened to accrual in December 2019, will recruit 180 caregivers from University Hospitals Seidman Cancer Center. Patients must be receiving radiation therapy for a diagnosis of stage I - III cancers of the rectum, anus, and esophagus; stage III NSCLC; or stage I – IV A/B head/neck cancer. Adult caregivers must be identified by the patient as their primary caregiver, who is providing daily assistance and/or emotional support. The intervention involves three in-person, one-on-one sessions during radiation treatments. The control group is usual care. Data will be collected at baseline, at the end of radiation treatment, and 4 and 20 weeks post-radiation treatment. The primary outcome is caregiver anxiety at 20 weeks postradiation treatment. Other caregiver outcomes include depression, health-related quality of life [HRQOL], and fatigue. Patient outcomes (HRQOL and interrupted treatment course) and healthcare utilization outcomes (unplanned hospital admission, emergency room visits, and use of intravenous fluids) will be measured. The analysis will consist of linear mixed model repeated measures, mediation and moderation tests, and Poisson regression methods. Clinical trial information: NCT04055948 .

Parameters for Nutrition Assessment.

Published in the January issue, the article “Pediatric Tracheostomy Wound Healing: A Retrospective Cohort Study” by Odom et al addresses the pediatric population, which is truly a vulnerable population in regard to pressure injuries. However, we question the authors’ use of albumin as a nutrition assessment marker. Historically, hepatic proteins such as albumin, prealbumin, and transferrin have been linked to nutrition status. However, recent published research, review articles, and editorials show that serum levels of these hepatic proteins correlate with morbidity and mortality rather than nutrition status. As of 2012, the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (ASPEN) do not recommend using hepatic protein levels for malnutrition diagnosis. The current ASPEN and Society for Critical Care Medicine Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient uphold this concept, stating: “In the critical care setting, the traditional serum protein markers (albumin, prealbumin, transferrin, retinol-binding protein) are a reflection of the acute phase response and do not accurately represent nutrition status in the ICU setting.”1 This concept holds true for general hospitalized patients.2,3 Further, the authors state that prealbumin would have been a preferred nutrition marker, although not available during their study. They further relay that prealbumin is widely used in wound care nutrition measurements because it is less expensive and not affected by hydration or renal issues. This is an incorrect statement; in the critical care patient, prealbumin may be as affected as albumin by these issues. Prealbumin levels may increase in the presence of renal failure because of impaired degradation of the kidney and therefore are also not an accurate nutrition marker.4,5 Aside from clinical considerations, the statement made by the authors that prealbumin is less expensive than albumin may be false in many institutions. Prealbumin actually may be more costly, especially in cases where laboratory tests must be sent off-site to be processed. Given advances in nutrition science, the following parameters to assess nutrition status are suggested instead: involuntary weight loss, muscle mass loss, subcutaneous fat loss, insufficient energy intake, fluid accumulation, and reduced handgrip strength.6 Correction of any nutrition deficits should be promptly addressed especially when preventing or healing pressure injuries. We invite all clinicians to consider the Academy of Nutrition and Dietetics, ASPEN, and the Society for Critical Care Medicine nutrition guidelines when designing future research and assessing nutrition. —Andy S. Chu, MS, RD, CD N, CNSC, FAND Food and Nutrition Services, NYU Langone Health, New York, NY —Barbara Delmore, PhD, RN, CWCN, MAPWCA, IIWCC-NYU Center for Innovations in the Advancement of Care, NYU Langone Health, New York, NY

Examining Factors That Contribute to Delayed Wound Healing in Children with Tracheostomy Wounds.

To identify variables that may contribute to delayed wound healing times in pediatric patients with tracheostomy wounds. Researchers identified 134 charts spanning January 2013 to June 2017; 95 charts met the inclusion criteria. The study examined Pressure Ulcer Scale for Healing (PUSH) scores, pressure injury staging, and albumin levels. Arkansas Children's Hospital. Patients (birth to 18 years) who developed or were admitted with a wound caused by a tracheostomy device. Time in days to wound closure. There was a moderate positive correlation between albumin and days to healing (r = 0.432, n = 22, P = .045) with higher albumin levels associated with shorter healing times. The PUSH scores and pressure injury stage were significant in explaining 14.1% of variance in days to healing (F77,2 = 7.458; P < .001). Wound healing appears to be multifactorial in nature in the pediatric population; albumin levels, pressure injury stage, and PUSH scores are all positively correlated with healing times. Further research is needed to investigate the contribution of race to healing time predication for the pediatric population.

Myiasis in a the Tracheotomy Wound: A Case Report

“Myiasis” is a parasitic infestation of live human or vertebrate animal tissues or cavities caused by dipterous larvae (maggots) which feed on the host’s dead or living tissue, liquid body substances or ingested food. The case is reported, probably the first in Bangladesh, tracheostomy myiasis. It was caused by infestation with larvae. The patient had undergone tracheostomy 3 years earlier and was a case of ca-larynx. The condition was treated by applying halothane to the tracheostomy wound, which caused spontaneous exit of approximately 30 larvae, easily removed with forceps. Predisposing factors could be: 1. Immuno-compromization due to post-irradiation state of patient; 2. Poor hygiene of tracheostomy tube; 3. Bad smell of wound, which attracts flies; 4. Living in a rural area deprived from necessary health care. Although this is not a lethal disorder, knowledge of the disease is necessary from the preventive, diagnostic and curative standpoint. It is important to proceed with identification of the larvae, distinguishing them from other types of myiasis involving different therapeutic implications.&#x0D; Bangladesh J Otorhinolaryngol; October 2016; 22(2): 119-121

Tracheastomal myiasis in ventilator dependant patient: case report and review of literature

A 51 year old severe morbidly obese female 1 week s/p tracheotomy with fenestration and PEG complicated by IDDM, ARF, CHF, COPD, OSA, and HVS was readmitted to hospital for tracheostomy wound myiasis and cellulitis. The patient had been admitted to a local long term assisted care facilty where the infection was noted. The patient was taken back to the OR where the tracheotomy tube was removed and oral ETT was placed. Wound debridement along with larvae removal was performed. Airway endoscopy was done to rule out presence of intra-luminary larvae. It was noted that the Bjork flap had become devitalized with the infection, leaving a 2 ring defect. The wound was packed with Dakin's Solution and daily wound care was done until no further larvae or necrotic tissue was seen. The patient was then taken back to OR where an anterior tracheal wall reconstruction was performed and replacement of trachostomy tube with removal of oral ETT. She was then transferred back to the ICU and long-term assisted care living.

Misplacement of the Nasogastric Tube into the Anterior Neck Potential Space

Nasogastric tube insertion is a very common procedure performed in intensive care settings which require a basic skill. In mechanically ventilated patients, the blind technique may lead to inadvertent placement of the tube into the lung even when the endotrachial cuff was inflated. The preferred technique is using a laryngoscopy for direct vision during the insertion. The gold standard of NGT placement confirmation in mechanically ventilated patient is with chest radiograph. Other clinical confirmation tests are not as reliable in intubated patients. A 44 year old lady came in with huge anaplastic carcinoma of the thyroid with compression symptoms. Otherwise, she had an unremarkable other medical problem. She underwent palliative debulking surgery to remove part of the tumor. The tumor was very aggressive, few days postoperatively it caused tracheal erosion with subcutaneous emphysema around the neck and upper chest. Urgent tracheostomy was done. Following this operation, NGT was reinserted. The nasogastric insertion was uneventful and the placement of the tube was confirmed by aspiration of gastric content and syringe test. Enteral feeding was resumed afterward. A few hours later the patient complained of neck pain and tense swelling developed on her neck and upper chest. Whitish secretion was noted to seep out around the tracheostomy wound. Enteral feeding was withheld and chest radiograph showed coiled NGT in the potential space of the anterior neck. The NGT was removed and surgical debridement was performed to evacuate the milk contamination. The case illustrates the importance of radiological confirmation of NGT placement in the ventilated patient.

Perioperative antibiotic prophylaxis in open tracheostomy: A preliminary randomized controlled trial

BackgroundThe efficacy of perioperative antibiotic prophylaxis for prevention of wound infection in open tracheostomy has been minimally studied and remains controversial. MethodsA preliminary double-blind, randomized, placebo-controlled trial was conducted. A total of 159 patients who underwent open tracheostomy were enrolled, and 88 patients were excluded because of lack of desire to participate in research, emergency condition, administration of other antibiotics, immunocompromise, or cervical skin infection. The remainings were randomly assigned to an antibiotic group or a control group. Another 11 patients were excluded after the randomization due to intraoperative contamination, death from the underlying disease, receiving other antibiotics, or lost to the follow-up. A total of 30 patients in each group were qualified for analysis. In the antibiotic group, clindamycin was intravenously administered 30 min before the incision and every 8 h after the operation for 24 h. In the control group, an equal volume of sterile saline was administered. ResultsWound infection developed in 2 patients (6.7%) in the antibiotic group and 7 patients (23.3%) in the control group (p = 0.08). In multivariate analysis, smoking and previous neck irradiation were the significant risk factors for wound infection (p = 0.042 and 0.019, respectively). The mean length of hospital stay after tracheostomy in patients with and without wound infection were 17 ± 2 days and 4 ± 2 days, respectively (p = 0.013). ConclusionThe result of this preliminary study reveals that antibiotic prophylaxis reduced tracheostomy wound infection rate from 23.3% to 6.7% although it was not statistically significant. However, wound infection may lead to serious complications and prolonged postoperative length of hospital stay, and therefore proper perioperative antibiotics should be considered in patients who are not receiving other antibiotics, and particularly in patients with risk factors for wound infection.

Prevention of post-operative pediatric tracheotomy wounds: A multidisciplinary team approach

ObjectiveTracheotomy-related pressure wounds have been reported as high as 29%. All advanced stage (stage 3 or 4) wounds are reported by hospitals, and CMS will no longer reimburse healthcare costs to manage them. We present the results of an intensive, multidisciplinary wound prevention strategy starting in the operating room at the time of tracheotomy placement. MethodsProspective analysis of a tracheostomy wound care protocol at an academic, tertiary-care pediatric hospital from September 2012 to February 2016. Participants include all patients having undergone tracheostomy placement followed by protocoled daily dressing changes until the first tracheostomy tube change by team consisting a senior level otolaryngology resident or pediatric otolaryngology fellow, certified wound care specialist, respiratory therapist, and bedside nurse. ResultsPost-operative tracheostomy-related wound data from 3 years prior to clinical intervention was obtained and compared to the intervention cohort. From March 2010–August 2012, 161 tracheotomy procedures were performed with 36 (22.4%) subsequent pressure wounds; 31% of these were stage 3 or 4 wounds. After multidisciplinary protocol implementation, there have been 121 additional tracheotomy procedures with reduction to 12 (9.9%) total tracheotomy-related wounds (p = 0.0064) and none (0%) were stage 3 or 4 (p = 0.0014). All stage 1 and 2 wounds were identified early, underwent appropriate intervention, and avoided further progression. ConclusionsThis protocol was successful in the elimination of all tracheostomy-related advanced stage, hospital-acquired pressure injuries and led to prompt identification of early stage wounds post-operatively.

Preventing Complications of Pediatric Tracheostomy Through Standardized Wound Care and Parent Education.

Pediatric tracheostomy is commonly performed for upper airway obstruction and prolonged mechanical ventilation. Children undergoing tracheostomy typically have multiple chronic medical problems that place them at high risk for readmission and additional complications. To determine whether the institution of a postoperative protocol for parent education and wound care with a nurse trained in tracheostomy care decreases the rate of readmission and other complications. A case series and medical record review was conducted of children 18 years and younger who underwent tracheostomy at a tertiary pediatric medical center between January 1, 2009, and December 31, 2014. A postoperative tracheostomy care and education protocol. Overall 30-day readmission rate, 30-day tracheostomy-related readmission rate, tracheostomy wound complications, and additional factors that may have affected readmission rates and wound complications (age at the time of tracheostomy, discharge location, indication for tracheostomy). A total of 191 children (118 boys and 73 girls) were included; of these, 112 participated in the education protocol and 79 children did not. Following institution of the education protocol, there was no decrease in the overall readmission rate (26.8% before the protocol vs 26.6% after the protocol; difference, 0.2%; 95% CI, -12.5% to 13.0%) or in the tracheostomy-related readmission rate (10.1% before the protocol vs 7.1% after the protocol; difference, 3.0%; 95% CI, -5.0% to 11.0%). Overall, 68.6% of readmissions were associated with medical comorbidities (95% CI, 55.9% to 81.3%). There was a significant decrease in tracheostomy-related wound complications after institution of the protocol (31.6% to 17.9%; difference, 13.7%; 95% CI, 1.6% to 26.0%). Multiple logistic regression analysis showed that children who were discharged home were significantly more likely to be readmitted for a tracheostomy-related complication than were patients discharged to an advanced care facility (odds ratio, 14.47; 95% CI, 3.08 to 67.92). Tracheostomy care requires expertise for all caregivers and is challenging for people without specialized training. Specialized nursing and education protocols are associated with decreased complications of tracheostomy wounds. Children who are discharged directly to home are at higher risk for readmission compared with children discharged to advanced care facilities. Further development of caregiver education protocols is necessary to continue to reduce readmissions and tracheostomy-related complications.

血管内治療で救命した顎動静脈瘻破裂症例

A 64-year-old woman with neurofibromatosis type 1 was admitted because of a sudden hematoma in her right neck and throat. To prevent an airway obstruction, tracheostomy was performed, but bleeding into the trachea persisted and was difficult to stop. Bleeding arose from a vessel lesion in the right parapharyngeal space, passed through the paratracheal space, and finally reached the tracheostomy wound. An arteriovenous fistula (AVF) in the maxillary artery was revealed by angiography. We diagnosed rupture of the varix resulting from venous high pressure caused by the AVF. The patient was treated by vascular interventional radiology (IVR). A large number of platinum coils were inserted and N-butyl-2-cyanoacrylate (NBCA) was embolized in the AVF and varix. Although innovative vascular IVR was better than surgery to treat AVF of the head and neck lesion, some problems were encountered. The cost for the provided medical services was high, and NBCA was not approved by the pharmaceutical affairs law in Japan.

Management of Tracheostomy Site Myiasis

Introduction Myiasis, from the Greek myia for “fly,” has been defined as the infestation of live human or vertebrate animals with larvae of the insect order Diptera (flies), which feed on living or necrotic tissue [1]. Myiasis can also be classified according to the site of infestation. Cutaneous myiasis involves the invasion of the skin, with the most common target being a wound, near which an obligatory or facultative parasitic fly will lay eggs [1,2]. In “wound myiasis,” both healthy and necrotic tissues can be fed on by the larvae, depending on the conditions and species of fly involved. Apart from the skin, the eyes, ears, nose, and sinuses represent relatively common sites of attack whereas less common sites are the mouth, throat, urogenital, and gastrointestinal tracts [1,2]. We present a case with tracheostomy wound myiasis and detailed description of its management. Case Blog A 62 year male patient presented with respiratory distress at ENT emergency. On indirect laryngoscopy a supraglottic mass was seen. The patient underwent emergency tracheostomy. A 7.5 mm cuffed tracheostomy tube was inserted. Biopsy was taken from the supraglottic growth under direct laryngoscopic view. Histopathologic report was well differentiated sqaumous cell cancer. The tracheostomy tube was changed to uncuffed tube and the patient was discharged following referral to radiotherapy department. The importance of proper tracheostomy tube care was well explained to the patient and his relatives. The patient was irregular during followup period and presented to ENT opd after 3 weeks with complaints of itching sensation at the tracheostomy wound site. On examination maggots were seen in the tracheostomy wound (Figures 1 and 2).