Double-muscle flap repair of the tethered tracheostomy scar.
Whether for facial trauma, extensive cancer resection, or long-term pulmonary ventilation, the final result after prolonged placement of a tracheostomy is usually a widened, depressed scar that is adherent to the underlying trachea. This adherence creates an unsightly up-and-down movement to the scar with swallowing. This "tracheal tug" is distressful emotionally to many patients and may even be painful. Simple methods of repair do not separate the skin closure adequately from the trachea, leading to recurrence of the tracheal tug. Use of the surrounding strap muscles to cover the trachea in conjunction with allogeneic dura mater has been described as one method of repair. In an attempt to perform a repair without the need for an outside tissue source, the double-muscle flap technique was developed. During this procedure the retracted scar is released from the trachea, the strap muscles are used to cover the tracheal closure, and the medial edge of the platysma muscle on each side is dissected free and sutured together in the midline. This separates effectively the tracheal closure from the skin, allowing the trachea to move independently. The cutaneous scar is revised along skin tension lines to create a fine-line linear scar. This procedure has been used in 2 patients with tracheal tug after prolonged tracheostomy placement. In each patient, the tracheal tug was eliminated completely, and an imperceptible cutaneous scar was the only remaining evidence of what had been a long and arduous recovery for these patients. In each case, patient satisfaction was complete. The authors recommend this technique as a simple and effective method of closure for these troublesome scars.
D000328:Adult; D000368:Aged; D002921:Cicatrix / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D013524:Surgical Flaps; D014139:Tracheostomy / Q000009:adverse effects*