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External peri-stomal skin granulations in paediatric tracheostomy: Incidence, outcomes and a proposed treatment

Luai Kawar1, Emma Clark2, Haytham Kubba2

  • 1University College Hospital, 235 Euston Road, London NW1 2BU, England, UK.

International Journal of Pediatric Otorhinolaryngology
|December 26, 2023
PubMed

Insights

External peri-stomal granulation after tracheostomy in children is common. Topical antimicrobials are recommended first-line treatment for stoma site granulation, with less recurrence but longer resolution times.

Area of Science:

  • Pediatric Otolaryngology
  • Wound Management
  • Tracheostomy Care

Background:

  • External peri-stomal granulation is a frequent complication following pediatric tracheostomy.
  • This condition can impede routine tracheostomy tube changes.
  • This study is the first to detail the incidence, outcomes, and treatment of pediatric peri-stomal granulation.

Purpose of the Study:

  • To describe the incidence and outcomes of external peri-stomal granulation in pediatric tracheostomy patients.
  • To propose a treatment algorithm for managing this common complication.

Main Methods:

  • Retrospective review of pediatric tracheostomy patients at the Royal Hospital for Children, Glasgow (January 2020 - May 2022).
  • Data collected included granulation presence, onset, resolution, recurrence, and treatment modalities.
  • All patients utilized silicone tracheostomy tubes.

Main Results:

  • 50 episodes of peri-stomal granulation occurred in 27 children (52%).
  • Younger children experienced more frequent granulation.
  • Topical steroid/antimicrobial ointment monotherapy showed longer resolution times but less recurrence when used initially.

Conclusions:

  • Non-invasive treatments, such as topical antimicrobials, are recommended as the initial approach for stoma-site granulations.
  • More invasive interventions (silver nitrate cautery, surgical excision) should be reserved for refractory cases or when granulation compromises tube changes.
Abstract

Keywords:
ChildrenComplicationsGranulationPaediatricsTracheostomy

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