Abstract
In recent years, airway management in infants has mainly been performed with endotracheal intubation, but there are still quite a few patients in whom tracheotomy is unavoidable. Granulation is the one of the secondary problems associated with tracheotomy. We investigated whether the method of tracheotomy was related to the occurrence of delayed peristomal and intratracheal granulation. We studied eight children who underwent tracheotomy at our department between 1988 and 2000, as well as 4 children who underwent tracheotomy at another clinic. The tracheotomy procedures were performed when the children were aged from 6 months to 16 years old. At our department, a longitudinal skin incision was made in all cases. A longitudinal incision was also made in the tracheal wall of 5 patients who were very low birth weight infants, or in whom the tracheal cannula was considered to be removable. An inverted U-shaped incision was made in 3 patients who required long-term airway management. Although injury to the cricoid cartilage and the first tracheal ring must be avoided, considering the possibility of future tracheal reconstruction, the performance of tracheotomy below the second or third tracheal rings should be avoided. Peristomal or intratracheal granulation occurred in 9 of our 12 patients, and methicillin-resistant Staphylococcus aureus (MRSA) was detected from the peristomal region in 7 of them. Therefore, MRSA infection seemed to be one of the factors precipitating the development of granulation.
