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Timing and risk factors for peristomal granulation in pediatric tracheostomy patients

Natsuki Takada1, Hiroshi Okuda2, Nansei Yamada3

  • 1Department of Otolaryngology-Head and Neck Surgery, Gifu Prefectural General Medical Center, Japan; Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Gifu University, Japan.

International Journal of Pediatric Otorhinolaryngology
|May 7, 2026
PubMed

Insights

Peristomal granulation is common in pediatric tracheostomy. The Björk flap technique delayed granulation onset, suggesting it may be a safer approach for pediatric airway management and stoma stabilization.

Area of Science:

  • Pediatric Surgery
  • Otolaryngology
  • Critical Care Medicine

Background:

  • Peristomal granulation is a frequent complication in pediatric tracheostomy patients, potentially impacting airway management.
  • Developing a tracheostomy technique that minimizes granulation is crucial for patient outcomes.

Purpose of the Study:

  • To compare peristomal granulation incidence and timing across different pediatric tracheostomy techniques.
  • To identify additional risk factors for granulation and assess long-term outcomes.

Main Methods:

  • Retrospective cohort study of 42 infants (<12 months) undergoing tracheostomy.
  • Evaluation of conventional, Starplasty, and Björk flap techniques.
  • Postoperative follow-up for at least one month.

Main Results:

  • Peristomal granulation occurred in 40% of patients, with no significant difference in incidence among techniques (conventional 42%, Starplasty 40%, Björk flap 38%).
  • The Björk flap technique demonstrated a significantly later onset of granulation compared to conventional and Starplasty methods (p=0.0218).
  • Long-term outcomes included successful decannulation (3), achieved oral intake (11), and ongoing home care needs (28).

Conclusions:

  • While granulation incidence was similar, the Björk flap method significantly delayed granulation onset.
  • The Björk flap technique may offer a safer pediatric tracheostomy approach by reducing early postoperative complications.
  • Early stoma stabilization is important, and the Björk flap's delayed granulation onset supports its use in pediatric patients.
Abstract

Keywords:
Björk flap methodPediatric tracheostomy patientsPeristomal granulation

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