Posttracheotomy granulation tissue managed by carbon dioxide laser excision

The problem of accumulation of granulation tissue and scar at the superior edge of the tracheostoma is a frequent problem in the management of chronic tracheotomy patients. This traditionally has been managed by cup forceps excision or by eversion through the tracheostoma with a skin hook and blind resection. These methods often lead to hemorrhage, and incomplete removal in a bloody field. We have used the carbon dioxide laser via a bronchoscope for ablation of the granulation tissue and/or scar at the stomal edge and at the tracheotomy tube proximal tip without morbidity in 13 pediatric cases. With experience, removal with the laser often proceeds more quickly than conventional methods. The scar and granulation tissue are excised under direct vision with minimal hemorrhage. We believe this to be a reasonable alternative in the management of this recurring problem.