Tracheostomy Scar Research Articles

Four-layer technique for tracheostomy scar treatment.

One important complication of the tracheostomy procedure is the depressed scar left after the tube is removed. A depressed tracheostomy scar can be aesthetically and functionally unacceptable. Tracheostomy scar treatment aims to fill lost soft tissue volume and correct tracheal skin tug. There are various techniques described to manage post-tracheostomy scars, including the use of autologous tissue or allogenic material and the creation of muscle flaps. In this article, the authors introduce a surgical method using four layers: the scar, the strap muscles, the platysma muscle, and the skin. This procedure has been used in two patients with depressed scar after prolonged tracheostomy placement. The tracheal tug was eliminated in each patient, and an imperceptible cutaneous scar remained. In each case, patient satisfaction was complete. The authors recommend this technique as a simple and effective method of closure for these troublesome tracheostomy scars.

Revision of the Retracted Posttracheostomy Scar by Anatomical Restoration; Four Layer Closure

AbstractMost tracheostomy scars are depressive and adherent to the underlying trachea, which causes up and down movement when swallowing. This tracheocutaneous tethering causes discomfort, pain, dysphagia, and bad appearance. A tracheocutaneous fistula may be accompanied. Here, we present a new method for reconstructing a tracheostomy scar deformity with tracheocutaneous tethering: layer-by-layer restoration of the anatomical structure with a subcutaneous fat tissue blanket. The scar tissue was fully excised, with the associated skin and subcutaneous tissue. The bilateral strap muscles around the scar were dissected proximally and distally and approximated to the midline, secured without tension. Bilateral platysma muscle flaps cover them firmly. The subcutaneous tissue around the incision margin, which included the superficial cervical fascia was elevated to form a fat blanket, closed transversely. The skin was closed after confirming the absence of retraction upon swallowing. From 2010 to 2018, 10 patients with tracheocutaneous tethering and one patient with tracheocutaneous fistula underwent surgery. All patients were functionally and aesthetically satisfied with the results. The only complication was a hypertrophic scar in one patient, which was managed with a triamcinolone injection. An anatomical layer-by-layer restoration with a fat blanket provided consistent, satisfying results for correcting tracheostomy scar deformities without using additional tissue. This simple method was effective for reconstructing tracheocutaneous tethering.

Surgical treatment of tracheocutaneous fistula and tracheostomy scars using a hinged flap and local myocutaneous flap.

Tracheocutaneous fistula and tracheostomy scar are complications associated with the prolonged use of tracheostomy tubes. They have functional and cosmetic problems owing to tracheal tugging during swallowing and easily visible scars. Although many procedures exist to correct this issue, there is no consensus on the optimal surgical technique. Therefore, an ideal surgical procedure was devised. The study was performed on 12 patients between September 2016 and May 2021. All patients had persistent tracheocutaneous fistulas or hypertrophic scars on the neck after tracheostomy. All procedures were performed using a hinged flap and two myocutaneous local flaps. All patients had no complications, and their aesthetics were excellent in postoperative photographs. The scar was better on the straight scar when the flap's skin is denuded than on the VY advancement flap. It should be noted, however, that this procedure can cause the flap to become congested in a short period after head and neck surgery. This procedure is safe, reliable and simple for surgical closure. This was found to produce excellent cosmetic results with no major complications.

A new surgical approach in the treatment of tracheostomy scars

The tracheostomy procedure presents some long term complications such as the depressed scar. It can be responsible for a tracheal tug, invaginated scar, inaesthetic scar or all of them. No consensus has emerged in the treatment of this type of pathological scarring. We want to propose a new surgical approach to correct all these three pathological scarring mechanism by a subcutaneous flap in single operation.

Submental intubation versus tracheostomy in maxillofacial fractures.

To compare submental intubation with tracheostomy in patients with maxillofacial fractures who were operated under general anesthesia and nasotracheal intubation was contraindicated. This prospective comparative study was conducted on 32 patients undergoing maxillofacial operations. All patients had a panfacial trauma (including naso-ethmoid orbital fracture combined with mandibular fracture). Patients who had unstable cervical vertebra, laryngeal trauma, urgent tracheostomy, and patients with expected prolonged postoperative ventilation were excluded from the study. Patients were randomly assigned to elective tracheostomy and submental intubation groups. The patients were evaluated according to the time required to do elective tracheostomy or submental intubation, the operation comorbidity and complications, and the postoperative scar. The average time required to do submental intubation was 8.35min versus 30.75min required to do elective tracheostomy with significant difference (p < 0.0001). No complication was reported with submental intubation while in elective tracheostomy group, surgical emphysema was registered in two patients. The submental scar was acceptable in all patients while the tracheostomy scar needs scar revision in four cases (p = 0.0325). Submental endotracheal intubation appeared to be a simple, safe, and significantly faster reliable alternative to tracheostomy during surgical reconstruction of selected cases of maxillofacial fractures without indication for prolonged postoperative ventilation support with significantly lower morbidity.

Atypical fibroxanthoma arising in a tracheostomy scar: A rare cicatricial neoplasm

Dear Editor, Atypical fibroxanthoma (AFX) is a cutaneous neoplasm that classically occurs in heavily sun‐damaged skin on the head and neck of elderly patients.1 We report the case of a 70‐year‐old man who presented with a 1‐year history of a slowly enlarging, nodular lesion on his anterior neck (Fig. 1). The lesion was asymptomatic, apart from scant straw‐yellow discharge that had emanated from the lesion since its onset. The lesion was at the site of a scar from a tracheostomy, which was performed 40 years earlier following a motor vehicle accident. On examination, a nontender, flesh‐coloured nodule was found at the superior aspect of the scar, with a central pit and serous crusting. The lesion was mobile with deglutition due to cicatricial tethering to the trachea. A punch biopsy revealed a pleomorphic tumour with immunohistochemistry consistent with AFX, and the excision specimen supported this diagnosis (Fig. 2a–c).

Tracheostomy scar management by repositioning platysma muscle and applying an acellular dermal substitute.

A depressed tracheostomy scar can be esthetically unacceptable. We describe a new technique for managing tracheostomy scars using platysma muscle repositioning and the application of an acellular dermal substitute. Seventeen patients with depressed tracheostomy scars were identified for scar management. The time between tracheostomy tube removal and scar management was 29 months. Before and after the surgery, the scar was rated using the Vancouver Scar Scale (VSS). After surgery, tracheal tug was eliminated in all patients and the appearance of the scar was much improved. The mean total VSS score improved from 8.265 to 2.324 (P < 0.0001). The follow-up period was 33.3 months. The management of tracheostomy scars by repositioning platysma muscle and applying an acellular dermal substitute is simple and efficient. The technique recovers the lost deep tissue volume, corrects tracheal skin tug, and enables tension-free skin closure to restore the normal contour of the neck.

Cervical Aerocele: A Rare Delayed Complication of Tracheostomy

Acquired cervical aerocele in adults is a rare condition and its delay development after tracheostomy decannulation is reported rarely. Our patient presented eight years after tracheostomy decannulation with a compressible anterior neck mass that only appeared when she coughed and could be deflated using manual compression. The mass was situated suprasternal at the previous tracheostomy scar. Computed tomography scan showed a paratracheal air sac without significant defect at the tracheal wall. Surgical intervention is the best treatment for symptomatic patients. As in this patient, we advise direct laryngoscopy and bronchoscopy for diagnostic and therapeutic purposes in such cases. However, our patient refused any surgical intervention.

Just a graze? Cephalic tetanus presenting as a stroke mimic

A 76-year-old right handed woman awoke with sudden onset of difficulty with swallowing, slurred speech and left-sided facial weakness and numbness. She had multiple vascular risk factors: hypertension, hypercholesterolaemia, impaired...

Management of Tracheostomy Scar by Autologous Fat Transplantation

Tracheotomy is a life-saving operation but may have bothersome sequelae. Because the defect resulting from tracheostomy is often allowed to repair spontaneously by secondary intention, hypertrophic scar formation is a frequent consequence. Furthermore, skin-to-trachea adhesions may develop, creating a "tracheal tug," that is, the skin movement in conjunction with the trachea, causing discomfort on swallowing. The aim of this study was to verify whether lipofilling could treat the aesthetic and functional disturbances by remodeling tracheostomy scars. Ten patients, aged 20 to 51 years, with retracted and/or hypertrophic tracheostomy scar underwent fat injection under local anesthesia or sedation. Fat harvesting was by a 2-mm blunt cannula connected to a 10-mL syringe. Before inserting the refined fat with a 19-gauge cannula, the fibrotic bands of the retracted scar between skin and underlying tissue were released with a sharp needle. The procedure required 2 sessions with an interval of 6 to 12 months. In the first session, 3.0 to 10 mL of fat were inserted. A further 3 to 5 mL were delivered during the second course. In 3 cases, scar excision was performed under local anesthesia as a final procedure. All 10 patients achieved an aesthetic and functional improvement and were satisfied with the result at long-term follow-up (mean, 21.3 months). Fat grafting proved to be a safe, minimally invasive, and effective procedure for the treatment of the tracheostomy scar both for functional and aesthetic purposes. It can be considered as a valid alternative to major open surgery.

Surgical tracheostomy in morbidly obese patients: technical considerations and a two-flap technique for access

In an era in which percutaneous tracheostomies are frequently performed in 'suitable' necks, more technically complex cases are referred to the otolaryngologist. We describe the surgical technique used and close cooperation required in securing the airway of a morbidly obese patient. A 52-year-old, morbidly obese man with significant comorbidities was referred for surgical tracheostomy following spinal fractures. This was complicated by a previous percutaneous dilatational tracheostomy scar. Tension-free skin advancement was not possible with a deeply plunging trachea; a vertical skin incision was dropped inferiorly to the sternum for access. A size 8 Shiley XLT Proximal Extension cuffed tracheostomy tube was inserted successfully. We describe safe airway surgery in a morbidly obese man, and outline requirements including the use of a specially designed operating table, the need for an elongated proximal limb tracheostomy tube, and the use of a distal two-flap technique for access to a deeply plunging trachea.

Tracheal Obstruction Due to Heterotopic Ossification in a Tracheostomy Scar

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Epidermoid cysts in head and neck: our experiences, with review of literature.

Epidermoid cysts are benign lesions, characterized by cystic spaces lined by simple squamous epithelium (epidermoid cyst), containing skin adnexa ("true" dermoid cyst) or tissues of all three germ layers (teratoid cyst). Head and neck constitute~7% of all cases of epidermoid and dermoid cysts. There is often a diagnostic dilemma with the more common cystic lesions of this region. A retrospective case-series study of histologically proved epidermoid cysts in the head-neck region, from February 2008 to January 2011, in the Department of Otorhinolaryngology and Head-Neck Surgery of a tertiary Government teaching hospital in eastern India. The diagnosis was reached by fine needle aspiration cytology FNAC and subsequent histopathology where feasible. Necessary imaging was done for evaluation and management. A total of 28 cases were analyzed. 5 were female, with a male: female ratio of 4.6. Age range was from 2 to 60years (mean=30). Excision was the preferred treatment in 20 cases (71.4%). Various sites like the submandibular region (5), pinna (5), sublingual region (1), periorbital (6), suprasternal (6), along the anterior border of sternocleidomastoid (1) and glabella (3) were involved, along with an iatrogenic implantation epidermoid cyst in a tracheostomy scar. Some of the interesting cases presenting with clinical dilemma have been emphasized. Epidermoid cysts are relatively less common in the head-neck region, hence are liable to be misdiagnosed. In this case-series, few cases presenting with enough elements of confusion and dilemma are discussed with overall analysis and review of the related literature.

Platysmal book flap for tracheostomy scars

Platysmal book flap for tracheostomy scars

Tracheostomy scar revision

Tracheostomy tube placement is a common procedure performed in patients with severe maxillofacial trauma. Many patients that do not require emergent intubation will require an elective tracheostomy at the time of maxillomandibular fixation and fracture repair due to oropharyngeal edema. After recovery and decanulation, these patients often have a resulting tracheostomy scar that is hypertrophy and discolored. The scar may be adherent (or tethered) to the underlying trachea which can be uncomfortable during swallowing. The objectives of surgical revision of a tracheostomy scar are to improve the appearance and symptoms of tracheocutaneous tethering. A variety of standard scar revision techniques are employed to fill the depressed scar and to separate the skin from the tracheal scar with mobilized strap muscles or grafting material, such as cadaveric acellular dermis.

Skin lesions after intensive care procedures: Results of a prospective study

Purpose To define the skin lesions produced by procedures used in the intensive care unit (ICU) and to examine patients 12 months after discharge from the ICU. Material and Methods This was a prospective clinical study in the 14-bed multidisciplinary ICU of a university hospital. Iatrogenic skin lesions (ISL) were examined in 316 patients after ICU discharge. Results A total of 189 patients were interviewed 12 months after ICU discharge. More than 85% of the patients had ISL after being discharged from the ICU. The patients with the highest Acute Physiology and Chronic Health Evaluation II score and longest average stay presented the highest number of ISLs. A total of 93 patients (49%) reported some skin lesions after 12 months. All patients who had undergone surgical tracheostomy reported the presence of a scar, but 4 of 24 patients who had undergone percutaneous tracheostomy reported no tracheostomy scar. Only 22% of all patients reported scars caused by vascular catheter access. About half (54.5%) of the patients reported secondary lesions caused by chest draining, and these were predominantly caused by the large-bore tube drainage. All patients reported the presence of a laparatomy scar. Conclusions Most patients had identified skin lesions resulting from ICU procedures. Half of all patients were aware of their lesions and reported them at 12 months. Future research is needed to understand whether these lesions cause problems to survivor's quality of life and whether the lesions lead to increased health care utilization.

Management of the Post‐Tracheostomy Scar

Tracheostomy scar management is aimed at filling lost deep tissue bulk, the correction of tracheal skin tug, and a tension-free closure that falls more naturally into the neck folds. Three cases are used to illustrate the major principles involved in the correction of tracheostomy scars. Those reconstructive principles are 1) re-approximation of individual layers of the neck for improved contour and release of tracheal skin tug, 2) filling of tissue deficit, using scar de-epithelialization, muscle flaps, or acellular dermal grafts, 3) excision of hypertrophic scarring or keloids, and 4) horizontal wound closure using simple closure or local skin flaps such as z-plasty. The goals and techniques outlined can resolve skin adherence to the trachea and can improve scar appearance in this noticeable location.

In Brief: Hoarseness

1. Eric Vance Hastriter, MD 2. John M. Olsson, MD 1. Brody School of Medicine East Carolina University Greenville, NC Hoarseness . In: Tunnessen WW. Signs and Symptoms in Pediatrics. 3rd ed. Philadelphia, Pa: Lippincott, Williams & Wilkins; 1999:328– 333 Disorders of Phonation in Children. McMurray JS. Pediatr Clin North Am. 2003;50 :363– 380[OpenUrl][1][CrossRef][2][PubMed][3] Hoarseness. Kenna MA. Pediatr Rev. 1995;16 :69– 72[OpenUrl][4][Abstract/FREE Full Text][5] Hoarseness is defined best as any change in vocal quality. Phonation occurs during exhalation when the vocal cords shorten and approximate or lengthen and separate through the actions of the thyroarytenoid and cricoarytenoid muscles, respectively. These muscles take their motor supply from the recurrent laryngeal nerve. The incidence of hoarseness reported in the literature varies between 5% and 40% and reflects diverse disorders. The history can help to narrow the differential diagnosis. Although the voice may sound normal to the examiner, the patient’s subjective view is more significant. Vocal quality (eg, breathy, alteration in pitch) is important, as is the duration of the symptom. Acute changes suggest trauma or inflammation; a chronic change may point to a structural lesion. Because allergy or gastroesophageal reflux may … [1]: {openurl}?query=rft.jtitle%253DPediatric%2Bclinics%2Bof%2BNorth%2BAmerica%26rft.stitle%253DPediatr%2BClin%2BNorth%2BAm%26rft.aulast%253DMcMurray%26rft.auinit1%253DJ.%2BS.%26rft.volume%253D50%26rft.issue%253D2%26rft.spage%253D363%26rft.epage%253D380%26rft.atitle%253DDisorders%2Bof%2Bphonation%2Bin%2Bchildren.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0031-3955%252803%252900028-2%26rft_id%253Dinfo%253Apmid%252F12809328%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0031-3955(03)00028-2&link_type=DOI [3]: /lookup/external-ref?access_num=12809328&link_type=MED&atom=%2Fpedsinreview%2F27%2F6%2Fe47.atom [4]: {openurl}?query=rft.jtitle%253DPediatrics%2Bin%2BReview%26rft.stitle%253DPediatr.%2BRev.%26rft.issn%253D0191-9601%26rft.aulast%253DKenna%26rft.auinit1%253DM.%2BA.%26rft.volume%253D16%26rft.issue%253D2%26rft.spage%253D69%26rft.epage%253D72%26rft.atitle%253DConsultation%2Bwith%2Bthe%2BSpecialist%253A%2BHoarseness%26rft_id%253Dinfo%253Adoi%252F10.1542%252Fpir.16-2-69%26rft_id%253Dinfo%253Apmid%252F7877913%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [5]: /lookup/ijlink?linkType=ABST&journalCode=pedsinreview&resid=16/2/69&atom=%2Fpedsinreview%2F27%2F6%2Fe47.atom

Split sternocleidomastoid muscle repositioning for correction of depressed post-tracheostomy scar and tracheal tug.

One important complication of tracheostomy procedure is the depressed scar left after the airway is removed. The problem is more challenging for the surgeon if tracheal tug accompanies. Six male patients with unaesthetic, depressed tracheostomy scars due to late removal of tracheostomy tubes after maxillofacial high-velocity gunshot injuries were treated. The patients' age ranged from 20 to 23 years, with an average age of 21 years. The mean tracheostomy tube removal time was 18 days (range, 9 to 34 days) postoperatively. The mean scar dimension was 13.4 mm x 14.4 mm x 4 mm (width, length, and depth, respectively). All patients showed tracheal tug and complained of swallowing discomfort. Under local anesthesia, split sternocleidomastoid muscle flaps were used bilaterally following excision of the skin scars and covered by adjacent skin flaps. The mean follow-up was 18 months. Cosmetic and functional results were satisfactory for all patients. Dysphagia disappeared in all patients following surgery. This technique is useful and easy to perform for reconstruction of complex post-tracheostomy scars.

Anterior frontal vertical partial laryngectomy

Anterior frontal laryngectomy is a treatment option for early glottic cancers involving the anterior commissure. The characteristic anatomy of the anterior commissure allows carcinomas to easily invade the cartilage, making its endoscopic removal unsafe. The surgical technique, as detailed in this article, includes the resection of the entire anterior commissure along with the anterior third of both vocal cords and the anterior portion of the thyroid cartilage. With the consequence of a hoarse voice but intelligible speech, and a tracheostomy scar, the patient can expect a high cure rate with no breathing or swallowing problems. Length of hospital stay and postoperative complications are minimal. Anterior frontal laryngectomy is a treatment option for early glottic cancers involving the anterior commissure. The characteristic anatomy of the anterior commissure allows carcinomas to easily invade the cartilage, making its endoscopic removal unsafe. The surgical technique, as detailed in this article, includes the resection of the entire anterior commissure along with the anterior third of both vocal cords and the anterior portion of the thyroid cartilage. With the consequence of a hoarse voice but intelligible speech, and a tracheostomy scar, the patient can expect a high cure rate with no breathing or swallowing problems. Length of hospital stay and postoperative complications are minimal.