[Application and efficacy of inverted U-shaped flap combined with prepositioned guidewire technique in airway management for patients with severe burns].

OBJECTIVE: To evaluate the efficacy of the inverted U-shaped flap combined with prepositioned guidewire technique in preventing accidental tracheal tube extubation in patients with severe burns complicated by inhalation injury, and to analyze its protective mechanisms.

METHODS: A retrospective cohort study was conducted. Patients with severe burns complicated by inhalation injury who were admitted to the department of burns and plastic surgery, Liuyang People's Hospital from July 2012 to September 2024 were enrolled. According to the time node of surgical technique modification, patients admitted before the modification (July 2012 to October 2018) were assigned to the conventional technique group, while those admitted after the modification (November 2018 to September 2024) were assigned to the modified technique group. The conventional group was treated with a longitudinal tracheal incision, whereas the modified group underwent an inverted U-shaped flap incision combined with prepositioned guidewires. Demographic and clinical data were collected, including gender, age, body mass index (BMI), total burn area, full-thickness burn area, and clinical outcomes [including in-hospital accidental extubation rate, extubation-related in-hospital mortality rate, extubation rescue success rate, and postoperative airway stenosis incidence during follow-up]. Additionally, the time to reintubation after accidental extubation was recorded. All patients were followed up for 6-8 months to monitor the occurrence of postoperative airway-related complications in surviving cases.

RESULTS: A total of 480 patients aged 30-56 years were included, with 356 males and 124 females. Among them, 288 patients were allocated to the conventional group and 192 to the modified group. The overall accidental extubation rate was 2.7% (13/480), with 2.8% (8/288) in the conventional group vs. 2.6% (5/192) in the modified group. Six of the eight extubated patients in the conventional group died due to reintubation difficulties, while all five extubated patients in the modified group achieved successful reintubation. The extubation-related in-hospital mortality rate [0% (0/192) vs. 2.1% (6/288)] and the incidence of airway stenosis [0% (0/192) vs. 2.8% (8/288)] were significantly lower in the modified group compared with the conventional group, and the extubation rescue success rate was significantly higher [100.0% (5/5) vs. 25.0% (2/8)]. Furthermore, the mean time to reintubation after extubation was significantly shorter in the modified group than in the conventional group (s: 96.60±10.33 vs. 250.00±16.97), all the differences were statistically significant (all P<0.05). Kaplan-Meier survival analysis revealed that the cumulative in-hospital survival rate of extubated patients was significantly higher in the modified group than in the conventional group (Log-rank test: χ 2=6.429, P=0.011). Postoperative follow-up showed that among the two extubated survivors in the conventional group, one developed airway stenosis during the follow-up period, all of whom required long-term airway intervention; all five extubated patients in the modified group survived to discharge with no airway complications observed during the follow-up period.

CONCLUSIONS: The inverted U-shaped flap combined with prepositioned guidewire technique can effectively improve the success rate of rescue after accidental tracheal tube extubation, shorten the time to reintubation, reduce extubation-related in-hospital mortality, and decrease the incidence of postoperative airway stenosis in patients with severe burns complicated by inhalation injury. This technique may be a preferred option for airway management in this patient population.