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Tracheostomies frequently supervene in unsightly neck scars. their leading neck location and the temporary indwelling breathing tube commonly leaves a depressed neck scar after its removal. It often looks like a belly button with the skin turned inward. this is known as a tracheal tug although it is the lack of fundamental soft tissue that makes it look this way.
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An undesired looking scar from a tracheostomy can feel revision within months after a breathing tube has been removed if so desired. Historically, tracheostomy revisions have been done when the scar is more mature. (greater than six months after tube removal) It is not essential to wait this long however. the plastic surgery techniques used are not no ifs ands or buts affected by how mature the tracheostomy scar is. And, for many patients, they would like to eliminate as soon as possible the bodily and psychological marks of the caress of why the tracheostomy was there in the first place.
To get a good outcome from a tracheostomy scar revision, there are three basic concepts that must be achieved surgically. first, the turned in skin edges must be released from the deeper tissues and be thoroughly freed up. secondly, this publish creates a real tissue volume blemish between the skin and the trachea which must be filled in. Lastly, windup the skin must create a fine line scar that lies in a horizontal direction along a natural neck skin fold. By far, filling in the lost tissue is the hardest one to achieve but it no ifs ands or buts essential if one does not want the final supervene to have any indentation. Filling in the missing tissue can be done in a variety of ways. if the tracheostomy scar is not that deep and fairly shallow, the surrounding skin edges can be used through a technique known as edge de-epithelization. the thinned skin edges are then turned down for a minuscule tissue fill and the full-thickness skin edges terminated over it. for tracheostomy scars that are significantly indented, however, more volume is required. I prefer using dermal-fat grafts which can be quite thick if desired, up to 1 cm. A donor site is needed to harvest it and this will leave a scar elsewhere on the body. however, if one has a scar from a former surgery elsewhere that is from a suitable area that has some fat thickness, then this should strongly considered. otherwise, allogeneic dermal grafts (from cadaver skin) can be used which is an off-the-shelf product.
Tracheostomy scar revision is a fairly straightforward patient procedure. All sutures are located under the skin so there is none to remove. A fine line red scar will exist for awhile afterwards (months) but this will eventually fade into a near invisible pencil line thin scar. Again the key to a prosperous tracheostomy scar revision is to thoroughly resolve the skin tethering to the trachea and replace any missing tissue.
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