Timing and risk factors for peristomal granulation in pediatric tracheostomy patients

Abstract

Background

Peristomal granulation occurs more frequently in pediatric than adult tracheostomy patients and may complicate postoperative airway management. Establishing a tracheal stoma resistant to granulation is therefore critical. This study evaluated differences in the incidence and timing of peristomal granulation according to tracheostomy technique, identified additional risk factors, and assessed long-term outcomes.

Methods

This retrospective cohort study included 42 pediatric patients who underwent tracheostomy at our institution between January 2015 and February 2025. All patients were younger than 12 months at surgery and were followed for at least one month postoperatively. Tracheostomy techniques included the conventional method, Starplasty, and the Björk flap method.

Results

Peristomal granulation developed in 17 patients (40%). The incidence did not differ significantly among techniques: conventional (42%), Starplasty (40%), and Björk flap (38%). However, the onset of granulation occurred significantly later in the Björk flap group compared with the other two techniques (p = .0218). This association remained significant after adjustment for inflammation-related confounding factors.

Regarding long-term outcomes, 3 patients were successfully decannulated, 11 achieved oral intake, and 28 required ongoing home care.

Conclusions

Although the incidence of peristomal granulation was similar among tracheostomy techniques, the Björk flap method was associated with a significantly delayed onset of granulation. Given the importance of early postoperative stoma stabilization, the Björk flap method may offer a safer tracheostomy approach in pediatric patients by reducing the risk of early complications.