Aitken Marguerite E, Hammond Dennis C
Center for Breast and Body Contouring, 4070 Lake Drive SE, Suite 202, Grand Rapids, MI 49546, USA.
Ann Plast Surg. 2002 Sep;49(3):328-32. doi: 10.1097/00000637-200209000-00017.
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.
无论是面部创伤、广泛的癌症切除手术，还是长期的肺部通气，气管造口术长期留置后的最终结果通常是一条增宽、凹陷且与下方气管粘连的瘢痕。这种粘连会导致瘢痕在吞咽时出现难看的上下移动。这种“气管牵拉”在情感上给许多患者带来困扰，甚至可能引起疼痛。简单的修复方法无法充分分离皮肤切口与气管，导致气管牵拉复发。已描述一种使用周围带状肌覆盖气管并结合同种异体硬脑膜的修复方法。为了在无需外部组织来源的情况下进行修复，开发了双肌瓣技术。在此手术过程中，将回缩的瘢痕从气管上松解，使用带状肌覆盖气管切口，将每侧颈阔肌的内侧边缘游离并在中线处缝合在一起。这有效地将气管切口与皮肤分离，使气管能够独立移动。沿着皮肤张力线修整皮肤瘢痕，形成一条细线状线性瘢痕。该手术已应用于2例气管造口术长期留置后出现气管牵拉的患者。在每例患者中，气管牵拉均完全消除，对于这些患者漫长而艰难的恢复过程，仅留下一条难以察觉的皮肤瘢痕作为唯一痕迹。在每例病例中，患者均完全满意。作者推荐该技术作为一种针对这些棘手瘢痕的简单有效闭合方法。
