Retrospective comparison of Velcro® and twill tie outcomes following pediatric tracheotomy

Objectives: To compare the rates of skin-related complications and accidental decannulation in pediatric patients who received Velcro (R) ties versus twill ties during the early postoperative period following tracheotomy. The rates of skin-related complications and accidental decannulation in patients with Velcro (R) ties was hypothesized to differ from those in patients with twill ties. Methods: Medical records of 109 patients <= 18 years old who underwent elective tracheotomy were reviewed: 70 received twill ties and 39 received Velcro (R) ties. Patients were followed for the first seven postoperative days. The primary outcome was skin-related complications, which were further categorized into mild (irritation) and severe (breakdown). The secondary outcome was accidental decannulation. Rates of skin-related complication and accidental decannulation were compared across the two groups using chi-square analysis. Results: Skin irritation occurred in 32 patients (45.7%) with twill ties and 10 patients (25.6%) with Velcro (R). Skin breakdown occurred in 20 patients (28.6%) with twill ties and 6 patients (15.4%) with Velcro (R). There were no accidental decannulation events. The use of Velcro (R) ties was associated with a decreased rate of skin irritation (OR: 0.41; 95% CI: 0.17-0.97; P = 0.039). Conclusions: The use of Velcro (R) ties was associated with a decrease in the rate of skin irritation. There were no accidental decannulation events. These findings support the use of Velcro (R) ties at the time of pediatric tracheotomy placement.