Long-term Flap Tracheostomy in a Pediatric Animal Model

Objective: To investigate the short- and long-term complications of pediatric tracheostomy, emphasizing posttracheostomy tracheal stenosis in an animal model. Design: Twenty-five New Zealand white rabbits were randomly assigned to three groups: flap tracheostomy, traditional vertical tracheostomy, and control. Interactive image analysis was used to compare the tracheal cross-section area and circumference between groups 16 weeks after surgery. The incidence of peristomal infections and accidental decannulations was also compared. Results: The vertical tracheostomy group had a smaller circumference (P=.01) and smaller cross-sectional area (P=.006) than the control or flap tracheostomy groups. A 30% decrease in tracheal cross-sectional area occurred in the vertical tracheostomy group. The flap tracheostomy group had fewer problems with accidental decannulation and peristomal infection compared with the vertical tracheostomy group. Conclusions: We found no significant risk of tracheal stenosis or adverse effects on tracheal growth for the flap tracheostomy in a developing animal model. This tracheostomy technique may be useful in the management of pediatric patients who require long-term bypass of the upper airway.