title: Enhanced tracheostomy wound healing using maltodextrin and silver alginate compounds in pediatrics: a pilot study.
abstract: BACKGROUND
  Tracheostomy wounds are commonly encountered in children but rarely reported. Relatively few treatments are available or have been investigated to manage this problem. Healing times for pediatric tracheostomy wounds are often unpredictable and protracted. Recent use of maltodextrin gel (MD) and a silver alginate sponge (AG) at our institution has demonstrated expedited healing and interest in this novel treatment for tracheostomy wounds.
  
  
  METHODS
  We conducted an 11-month retrospective review of children with wound complications following tracheostomy placement at a tertiary care facility. Wounds were evaluated and rated based upon the National Pressure Ulcer Advisory Panel staging system. Subjects identified with stage 2 or greater tracheostomy-related ulcers treated with MD and/or AG were included. Subject characteristics and wound healing rates were tabulated in a database that included age, wound site, initial and final wound stage, type of treatment, length of treatment, and complications. Tracheostomy wounds treated as an out-patient were excluded from the study.
  
  
  RESULTS
  Eighteen subjects, which included both in-patients and out-patients, were treated with AG and/or MD during the study period for tracheostomy-related wounds. Of the 26 subjects with tracheostomies performed during the study period, 10 (38.5%) were treated for postoperative wounds. A total of 11 subjects completed their in-patient wound treatment and were thus included in the study. Average subject age was 5.3 y (range 0.25-15.6 y). Wound locations were as follows: infrastomal region (n = 8), stoma (n = 2), and lateral neck (n = 1). Six subjects had stage 2 wounds, 4 had stage 3 wounds, and 1 had a stage 4 ulcer. All wounds achieved complete epithelialization following treatment with MD and/or AG. The average length of treatment was 12.8 d (range 6-28 d). No adverse effects were identified.
  
  
  CONCLUSIONS
  Postoperative tracheostomy wounds are common. The use of MD and AG provides an effective and safe treatment for tracheostomy-related ulcers.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital.
authors.forename: Larry D
authors.initials: LD
authors.lastname: Hartzell
authors.affiliation: College of Medicine, University of Arkansas for Medical Sciences.
authors.forename: Tara N
authors.initials: TN
authors.lastname: Havens
authors.affiliation: Physical Therapy Department, Division of Wound Care, Arkansas Children's Hospital.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Odom
authors.affiliation: Otolaryngology Department, Arkansas Children's Hospital.
authors.forename: Tanya G
authors.initials: TG
authors.lastname: Stillman
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Boswell
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Bower
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital.
authors.forename: Gresham T
authors.initials: GT
authors.lastname: Richter
mesh_terms: D000293:Adolescent; D000464:Alginates / Q000009:adverse effects / Q000627:therapeutic use*; D047070:Bandages, Hydrocolloid; D002648:Child; D002675:Child, Preschool; D005260:Female; D005782:Gels; D006801:Humans; D007223:Infant; D008297:Male; D010865:Pilot Projects; D011134:Polysaccharides / Q000009:adverse effects / Q000627:therapeutic use*; D012834:Silver / Q000009:adverse effects / Q000627:therapeutic use*; D012883:Skin Ulcer / Q000209:etiology / Q000628:therapy*; D014139:Tracheostomy / Q000009:adverse effects*; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000464:Alginates; D005782:Gels; D011134:Polysaccharides; D012834:Silver; C008315:maltodextrin
keywords: Algidex; Multidex; complication; maltodextrin; pediatric; pressure ulcer; silver alginate; tracheostomy; ulcer; wound; wound care