Introduction Percutaneous dilatational tracheostomy (PDT) is a wide- ly used and accepted method for long-term ventilation of critically ill patients. Especially the procedure with grad- ed dilators described by Ciaglia et al. has met with great interest since its first description in 1985 [1]. Prospective clinical studies have demonstrated the low early compli- cation rate [2±5] and the rarity of clinically relevant tra- cheal stenosis [3, 6±8]. The latter data are surprising as PDT involves intercartilaginous insertion of the cannula with long-term compression of the tracheal rings, which may cause partial tracheal necrosis and, subsequently, stenosis. To understand the discrepancy between clini- cally found and theoretically expected rates of tracheal stenosis, clinico-pathological studies of tracheas follow- ing PDTare useful. Additionally, these analyses can doc- ument the height of blind puncture of the trachea. In the following report we present our morphological data on 42 tracheal specimens after PDT with special re- gard to accuracy of tracheal puncture as well as the type and extent of tracheal wall lesion. M.K. Walz U. Schmidt Tracheal lesion caused by percutaneous dilatational tracheostomy ± a clinico-pathological study Received: 3 June 1998 Final revision received: 31 August 1998 Accepted: 2 September 1998 M.K. Walz ( ) ) Department of General Surgery, Medical School, University of Essen, Hufelandstrasse 55, D-45 122 Essen, Germany Tel. + 49 201 723 1111; Fax + 49 201 723 5946 U. Schmidt Institute of Pathology, Medical School, University of Essen, Hufelandstrasse 55, D-45 122 Essen, Germany Abstract Objective: To analyse the accuracy of cannula placement and the extent of tracheal lesions of the anterior tracheal wall after percuta- neous dilatational tracheostomy (PDT). Design: A clinico-pathological study of tracheal specimens following PDT. Setting: University hospital. Materials: Forty-two tracheal speci- mens of intensive care patients (24 male, 18 female; age: 23±70 years) who died unrelated to tracheostomy. Interventions: Using tracheoscopic guidance, PDTs were performed by Ciaglia's method. Tracheal cannulas with outer diameters of 11±12 mm were used. The duration of cannula- tion ranged from 1 to 97 days (me- dian: 10.5 days). Results: PDTs were placed between the 1st and 4th tracheal rings in 32 cases, above the first ring in 7 cases and below the 4th in 3 cases. Twenty specimens showed a horizontal in- tercartilaginous rupture of the ante- rior tracheal wall, 12 tracheas addi- tionally had fractures of tracheal rings and in 10 specimens defects of tracheal cartilage (range: 15 mm 2 ± 120 mm 2 ) were found. The occur- rence of tracheal defects was influ- enced by the height of puncture (p < 0.05) and duration of cannula- tion (p < 0.01). Conclusion: Misplacement of the tracheal cannula above or below the intended tracheal area occurred in one-fourth of our patients. The typi- cal tracheal lesion following PDT is transverse rupture of the anterior tracheal wall with or without frac- ture of neighbouring rings. Extend- ed cartilaginous defects are rare, which may explain the low rate of tracheal stenosis following PDT. Key words Percutaneous dilatational tracheostomy × Tracheal lesion × Clinico-pathological study Intensive Care Med (1999) 25: 102±105 Ó Springer-Verlag 1999 BRIEF REPORT