A New Technique in Management of Depressed Posttracheostomy Scars

Yazar, Sevgi Kurt; Yüce, Erkan; Serin, Merdan; Yazar, Memet; Gül, Zeliha; Irmak, Fatih; Şirvan, Serhat Selami

doi:10.1097/sap.0000000000001531

Cited by 5 publications

(9 citation statements)

References 16 publications

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“…A depressed and xed tracheal scar produces "tracheal tug", which occurs when the skin and the trachea move concurrently. Tracheal tug can cause dysphagia and pain with either lateral or vertical head movement in addition to an aesthetically unpleasing scar [9,10,24,25]. In a presented study all persons in OST group underwent a small 2.5-3 cm horizontal neck incision and vertical tracheal rings incision, without Bjork ap formation.…”

Section: Discussionmentioning

confidence: 93%

Evaluation of Post-tracheostomy`s Scars and its Impact on Persons Quality of Life: A Case Control Study

Shahparonyan

Poghosyan

Minasyan

et al. 2021

Preprint

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Background: Tracheostomy is one of the more commonly performed procedures in critically ill patients. Postoperative scarring is one of the bothersome sequelae of tracheostomies. Scars distorted the physical appearance, especially when found on the head and neck, which could cause a negative impact on quality of life. The aim of this study was to evaluate and assess the impact on quality of life of post-tracheostomy`s scars, depending on the method of tracheostomy.Methods: The prospective, single-center observational case-control study was conducted. One hundred and fifty-six persons with more than four months of post-tracheostomy surgical scars presence were observed using the Patient and Observer Scar Assessment Scale and Dermatology Life Quality index questionnaire. Persons were divided on two groups depending on method of performed tracheostomy, and duration of cannulated period was considered in both groups. Statistical analyses were performed by using SPSS ver. 16.0 (SPSS Inc., Chicago, IL, USA) and p-values of <0.05 were considered significant.Results: The patients who had a tracheostomic tube cannulation period of less than 15 days had better cosmetic results than those who had tracheostomic tubes for more than 15 days, regardless of the method of tracheostomy 6.64± 0.082 vs. 16.15± 0.096 (p<0.001) in surgical tracheostomy group and 7.26± 0.211 vs.14.17± 0.379 (p<0.05) in percutaneous dilatational group. The Dermatology Life Quality index scores have shown a mean value of 0.6 ±0.01, which means that post-tracheostomy scarring in the presented study, had no effect on the person's quality of life.Conclusions: Aesthetic outcomes of post-tracheostomy`s scars after the open surgical tracheostomy technique, performed using a minimally invasive approach, did not statistically differ from those of the percutaneous dilatational technique. Persons with a long duration of tracheostomic tube ventilation showed worse aesthetic outcomes compared with short-term tracheostomic cannulation, not dependent on the tracheostomy performing technique.The Dermatology Life Quality index have shown that post-tracheostomy`s scarring in the presented study had no effect on the person's quality of life.Trial registration: ISRCTN24668317 (IRB no.YSMU №7/18-19). Date of registration 23/04/2019

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Section: Discussionmentioning

confidence: 93%

Evaluation of Post-tracheostomy`s Scars and its Impact on Persons Quality of Life: A Case Control Study

Shahparonyan

Poghosyan

Minasyan

et al. 2021

Preprint

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“…A depressed tracheostomy scar can be aesthetically unacceptable, very distressing to the patient, and affect the quality of life 6,9 . Minimally invasive tracheostomy techniques with short horizontal skin incisions usually heal with a small horizontal linear scar without significant puckering or irregularity 25 . Some studies have noted that OST has higher postoperative scarring incidence than PDT, but none of them describes the technique for the tracheostomies in their works (the length of incision, horizontal or vertical direction) 6,12,14,21 .…”

Section: Discussionmentioning

confidence: 99%

“…6 , 9 Minimally invasive tracheostomy techniques with short horizontal skin incisions usually heal with a small horizontal linear scar without significant puckering or irregularity. 25 Some studies have noted that OST has higher postoperative scarring incidence than PDT, but none of them describes the technique for the tracheostomies in their works (the length of incision, horizontal or vertical direction). 6 , 12 , 14 , 21 In the present study, no statistically significant difference was observed in the OST and PDT groups by the observer or patient components of the POSAS.…”

Section: Discussionmentioning

confidence: 99%

“…The major reconstructive principles of tracheostomy scar correction are re‐approximation of individual layers of the neck for improved contour and release of tracheal skin tug, filling of tissue deficit, using scar de‐epithelialization, muscle flaps, or acellular dermal grafts, excision of hypertrophic scarring or keloids, and horizontal wound closure using simple closure or local skin flaps such as z‐plasty. 10 , 25 , 28 It is important to treat each case individually and to provide treatment that is best suited to the patient's needs. 24 …”

Section: Discussionmentioning

confidence: 99%

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Evaluation of post‐tracheostomy scars and their impact on persons' quality of life: A case‐control study

Shahparonyan

Poghosyan

Minasyan

et al. 2022

International Wound Journal

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Tracheostomy is one of the more commonly performed procedures in critically ill patients under mechanical ventilation. Postoperative scarring is one of the bothersome sequelae of tracheostomies. Scars distort physical appearance, especially when found on the head and neck, which could have a negative impact on quality of life. The aim of this study was to evaluate and assess the impact of post-tracheostomy scars on quality of life according to the tracheostomy method. A prospective, single-center, observational, case-control study was conducted. One hundred fifty-six persons with a post-tracheostomy surgical scar for more than four months were observed using the Patient and Observer Scar Assessment Scale and Dermatology Life Quality Index questionnaire. Persons were divided into two groups depending on the method of tracheostomy, and the duration of the cannulated period was considered in both groups. Statistical analyses were performed using SPSS ver. 16.0 (SPSS Inc., Chicago, IL, USA), and P values of <0.05 were considered significant. The patients who had a tracheostomic tube cannulation period of fewer than 15 days had better cosmetic results than those who had tracheostomic tubes for more than 15 days, regardless of the tracheostomy method: 6.64 ± 0.082 versus 16.15 ± 0.096 (P < 0.001) in the surgical tracheostomy group and 7.26 ± 0.211 versus 14.17 ± 0.379 (P < 0.05) in the percutaneous dilatational group. The Dermatology Life Quality Index scores had a mean value of 0.6 ± 0.01, which means that post-tracheostomy scarring in the present study had no effect on the person's quality of life.The aesthetic outcomes of post-tracheostomy scars after the open surgical tracheostomy technique did not significantly differ from those of the percutaneous dilatational technique in the present study. Persons with a long duration of tracheostomic tube ventilation showed worse aesthetic

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“…To correct depression, local muscles, such as the strap muscles, sternocleidomastoid muscles, or platysma muscles, have been advanced, transposed, split, or turned over. 3,[6][7][8][9] To prevent adhesion, autologous or biomaterial grafts have been used as an interposition graft. 4,5,[10][11][12] There are several types of biomaterial grafts.…”

Section: Videomentioning

confidence: 99%

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

Cho,

Lee,

Kang

2024

Arch Plast Surg

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Most 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.

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A New Technique in Management of Depressed Posttracheostomy Scars

Abstract: We think that this technique, which gives functionally and aesthetically satisfying results, can be used safely in depressed scars formed after tracheostomy and treatment of functional impairment due to this procedure.

Cited by 5 publications

References 16 publications

Evaluation of Post-tracheostomy`s Scars and its Impact on Persons Quality of Life: A Case Control Study

Evaluation of Post-tracheostomy`s Scars and its Impact on Persons Quality of Life: A Case Control Study

Evaluation of post‐tracheostomy scars and their impact on persons' quality of life: A case‐control study

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

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