Surgical Management of Tracheostomy in Patients with Severe Burns and Cervical Involvement: Impact on Cervical Wound-Healing Disturbance.

Abstract

<h4>Background</h4>Major cervical burns often require tracheostomy (TT); however, it remains unclear whether TT timing relative to cervical wound coverage (WC) and the choice of coverage modality affect peristomal wound healing.<h4>Methods</h4>In this retrospective single-center cohort study, we included 48 adults with thermally induced cervical burns who underwent TT between 2015 and 2024 in a specialized burn ICU. Eleven patients died before decannulation and were excluded from the primary endpoint analysis. Cervical wound-healing disturbance (CWHD) as a primary endpoint was assessed in the remaining 37 patients, including 13 treated with advanced cervical dressings and 24 treated with split-thickness skin grafts (STSG).<h4>Results</h4>CWHD occurred in 2/13 (15.4%) with advanced dressings and 11/24 (45.8%) after STSG. Within the grafted subgroup, complication rates did not differ significantly according to TT sequencing relative to WC, TT-WC interval, grafting technique (mesh vs. Meek), or tracheostoma closure method (all <i>p</i> > 0.05). In multivariable logistic regression, only cervical burn depth independently predicted CWHD.<h4>Conclusion</h4>In patients with cervical burns requiring TT, burn depth/severity, rather than TT timing, grafting strategy, or closure technique, appears to drive peristomal wound complications, supporting individualized planning instead of rigid algorithms.