[Critical analysis of complications and disorders in wound healing after tracheostomy in children].

BACKGROUND

The analysis of early and late postoperative results after tracheostomy in children.

METHODS

A 6 year, prospective, observational cohort study was undertaken in 14 children of mean age 4 years 7 months (range 0.03 month-15 years) at the Department of Otorhinolaryngology, University of Ulm. Children were included if they had at least two follow-up examinations postoperatively because of local disorders in wound healing of the tracheostoma. Etiologic factors, the type of tracheotomy, the size and type of the tracheostomy tube, primary and secondary local disorders in wound healing of the tracheostoma, and the clinical follow-up were analyzed.

RESULTS

Formation of granulation tissue and tracheal stenosis were the most observed local disorders. In five patients, the tracheal stenosis was located below the stoma, in one patient also above the stoma. A stenosis of the stoma was found in two patients. One patient died because of a tracheoinnominate artery fistula. In 10 patients problems in swallowing and recurrent aspiration of saliva was observed early postoperatively.

CONCLUSIONS

The tracheotomy in childhood is often related with late wound healing disorders. An association of wound healing disorders with a feasible lethal outcome is rarely found. Local formation of granulation tissue renders decannulation more difficult. The choice of a correctly fitting tracheostomy tube and special care of the tracheostoma in long-term cannulated children has to be emphasized.