Oztürk Serdar, Aksu Mete, Sengezer Mustafa
Department of Plastic and Reconstructive Surgery, GMMA, Gülhane Military Medical Academy, Ankara, Turkey.
Ann Plast Surg. 2004 Sep;53(3):240-4. doi: 10.1097/01.sap.0000116246.16674.e5.
One important complication of tracheostomy procedure is the depressed scar left after the airway is removed. The problem is more challenging for the surgeon if tracheal tug accompanies. Six male patients with unaesthetic, depressed tracheostomy scars due to late removal of tracheostomy tubes after maxillofacial high-velocity gunshot injuries were treated. The patients' age ranged from 20 to 23 years, with an average age of 21 years. The mean tracheostomy tube removal time was 18 days (range, 9 to 34 days) postoperatively. The mean scar dimension was 13.4 mm x 14.4 mm x 4 mm (width, length, and depth, respectively). All patients showed tracheal tug and complained of swallowing discomfort. Under local anesthesia, split sternocleidomastoid muscle flaps were used bilaterally following excision of the skin scars and covered by adjacent skin flaps. The mean follow-up was 18 months. Cosmetic and functional results were satisfactory for all patients. Dysphagia disappeared in all patients following surgery. This technique is useful and easy to perform for reconstruction of complex post-tracheostomy scars.
气管切开术的一个重要并发症是气管移除后留下的凹陷性瘢痕。如果伴有气管牵拉，该问题对外科医生来说更具挑战性。对6例因颌面高速枪伤后气管切开管移除延迟而出现不美观、凹陷性气管切开瘢痕的男性患者进行了治疗。患者年龄在20至23岁之间，平均年龄为21岁。气管切开管的平均移除时间为术后18天（范围为9至34天）。瘢痕的平均尺寸为13.4毫米×14.4毫米×4毫米（分别为宽度、长度和深度）。所有患者均表现出气管牵拉，并主诉吞咽不适。在局部麻醉下，双侧使用劈开的胸锁乳突肌瓣，切除皮肤瘢痕后，用相邻的皮瓣覆盖。平均随访时间为18个月。所有患者的美容和功能效果均令人满意。术后所有患者的吞咽困难均消失。该技术对于复杂气管切开术后瘢痕的重建是有用且易于实施的。
