Early tracheostomal healing in rabbits with use of various tracheal incisions

Various tracheal incisions (vertical, horizontal, or window) are used by surgeons for creation of a tracheostomy. The inflammatory response and healing varies with each incision and may contribute to complications such as tracheal stenosis. This study evaluates the effect of these tracheotomies on early stomal wound healing in a rabbit model. Male juvenile New Zealand rabbits underwent tracheotomy, with each animal randomized to the type of tracheal incision used (vertical, horizontal, or window). After recovery, they were killed on postoperative days 2, 4, 6, and 8, with tissue removed for histologic examination. Paraffin-embedded stomal sections were analyzed quantitatively for amounts of granulation tissue, fibrosis, and epithelization. Groups were compared statistically using chi-square, ANOVA, Spearman's rho, and Mann-Whitney U tests with p less than 0.05 considered significant. Fibrosis was significantly increased in the vertical and horizontal groups when compared with the window group. This increase was statistically significant between postoperative days 2 and 4 (p < 0.05). The amount of granulation tissue was only significantly increased in the window group, whereas no difference was seen in the rate at which epithelization occurred with the various incisions. Vertical and horizontal tracheal wounds have less granulation tissue formation and more fibrosis compared with window tracheotomies during initial wound healing. This could lead to a "safer" tracheostomy tract in the early postoperative period.