Skigen A L, Bedrock R D, Stopperich P S
Department of Oral and Maxillofacial Surgery, University of Florida, Jacksonville, USA.
Plast Reconstr Surg. 1999 May;103(6):1703-5. doi: 10.1097/00006534-199905060-00021.
Many methods have been developed for the correction of tracheal tug and scar depression. Early authors did well in correcting scar depression, but the correction of tracheal tug was more difficult. One method used to limit scarring is intralesional steroid injections. Repeated steroid injections inhibit healing, which could also limit skin-to-trachea adhesions. Carlson et al. were the first to advocate the use of an alloplastic barrier to prevent tracheal tug. Lyophilized dura has been used for several years by various surgical specialties. Microscopic studies have shown no host response; in fact, fibroblastic ingrowth is common. The use of alloplastic dura ensures that there is no contracture between the trachea and the skin, thus preventing tracheal tug. Alternatives to this method include soft-tissue procedures (as previously mentioned) to add bulk and then triamcinolone acetonide injections to prevent adherence and scarring. It is important to treat each case individually and to provide treatment that is best suited to the patient's needs. The method used in these case reports not only eliminates scar depression, but prevents tracheal tug as well.
已经开发出许多用于纠正气管牵拉和瘢痕凹陷的方法。早期的作者在纠正瘢痕凹陷方面做得很好，但纠正气管牵拉则更困难。一种用于限制瘢痕形成的方法是病灶内注射类固醇。反复注射类固醇会抑制愈合，这也可能限制皮肤与气管的粘连。卡尔森等人是第一个主张使用异体屏障来预防气管牵拉的。冻干硬脑膜已被多个外科专业使用数年。显微镜研究表明没有宿主反应；事实上，成纤维细胞向内生长很常见。使用异体硬脑膜可确保气管与皮肤之间不会挛缩，从而防止气管牵拉。这种方法的替代方法包括软组织手术（如前所述）以增加组织量，然后注射曲安奈德以防止粘连和瘢痕形成。针对每个病例进行个体化治疗并提供最适合患者需求的治疗非常重要。这些病例报告中使用的方法不仅消除了瘢痕凹陷，还预防了气管牵拉。
