Investigation of the effects of three different tracheotomy techniques on tracheal complications and decanulation in pediatric patients

The aim of the study is investigate effects of three different tracheotomy techniques on suprastomal complications and decanulation in pediatric patients. In our study, 62 patients in 0-3 age range are included. Patients which direct laryngoscopy was performed and its images were reached in the postoperative period are included. The patients were divided into three groups according to the tracheotomy technique; vertical incision+traction suture technique group (n:24), vertical incision+maturation suture technique group (n:19), inferior based flap (Björk) technique (n:19). Tracheotomy related complications of patients in all groups were examinated with direct laryngoscopy images in the postoperative period; we determinated whether tracheocutaneous fistula developed in patients who could be decanulated. In the suprastomal region, ≥50% (severe) collapse + granulation tissue was detected as 15.8% in the vertical incision + maturation suture group, 26.3% in the inferior based flap (Björk) technique group, 29.2% in the vertical incision+traction suture group (p=0.656). In the early period, ≥50% (severe) suprastomal region pathology was detected as 8.3% in the vertical incision+traction suture group, 9.1% in the vertical incision + maturation suture group, and 13.3% in the inferior-based flap (Björk) technique group (p = 1.0). In the late period, ≥50% (severe) suprastomal region pathology was detected as 15.4% in the vertical incision+maturation suture group, 36.4% in the inferior based flap (Björk) technique group, and 37.5% in the vertical incision+traction suture group (p = 0.423). The accidental decanulation rate was detected as 10.5% in the inferior based flap (Björk) technique group, 20.8% in the vertical incision+traction suture group and 26.3% in the vertical incision+maturation suture group (p = 0.442). The rate of life-threatening occurrence until recanulated was detected as 60% in the vertical incision + traction suture group, 20% in the vertical incision+maturation suture group and 0% in the inferior-based flap (Björk) technique group (p = 0.394). The rate of tracheocutaneous fistula was detected as 40% in the vertical incision+maturation suture group, 33.3% in the inferior based flap (Björk) technique group, and 13.3% in the vertical incision+traction suture group (p= 0.337). We think that it can be beneficial to use both maturation suture in order to prevent suprastomal pathologies and Björk flap technique in order to make recanulation easier after accidental decanulation.