Mazzola Isabella C, Cantarella Giovanna, Mazzola Riccardo F
Department of Specialistic Surgical Sciences, Università degli Studi di Milano, Milan, Italy.
J Craniofac Surg. 2013 Jul;24(4):1361-4. doi: 10.1097/SCS.0b013e318292c1a4.
Tracheotomy is a life-saving operation but may have bothersome sequelae. Because the defect resulting from tracheostomy is often allowed to repair spontaneously by secondary intention, hypertrophic scar formation is a frequent consequence. Furthermore, skin-to-trachea adhesions may develop, creating a "tracheal tug," that is, the skin movement in conjunction with the trachea, causing discomfort on swallowing. The aim of this study was to verify whether lipofilling could treat the aesthetic and functional disturbances by remodeling tracheostomy scars.
Ten patients, aged 20 to 51 years, with retracted and/or hypertrophic tracheostomy scar underwent fat injection under local anesthesia or sedation. Fat harvesting was by a 2-mm blunt cannula connected to a 10-mL syringe. Before inserting the refined fat with a 19-gauge cannula, the fibrotic bands of the retracted scar between skin and underlying tissue were released with a sharp needle. The procedure required 2 sessions with an interval of 6 to 12 months. In the first session, 3.0 to 10 mL of fat were inserted. A further 3 to 5 mL were delivered during the second course. In 3 cases, scar excision was performed under local anesthesia as a final procedure.
All 10 patients achieved an aesthetic and functional improvement and were satisfied with the result at long-term follow-up (mean, 21.3 months).
Fat grafting proved to be a safe, minimally invasive, and effective procedure for the treatment of the tracheostomy scar both for functional and aesthetic purposes. It can be considered as a valid alternative to major open surgery.
气管切开术是一种挽救生命的手术，但可能会有令人困扰的后遗症。由于气管造口术造成的缺损通常任其通过二期愈合自行修复，肥厚性瘢痕形成是常见的后果。此外，皮肤与气管之间可能会形成粘连，产生“气管牵拉”，即皮肤随气管一起移动，导致吞咽时不适。本研究的目的是验证脂肪填充是否可以通过重塑气管造口术瘢痕来治疗美学和功能障碍。
10例年龄在20至51岁之间、气管造口术瘢痕退缩和/或肥厚的患者在局部麻醉或镇静下接受脂肪注射。通过连接到10毫升注射器的2毫米钝头套管采集脂肪。在使用19号套管插入精制脂肪之前，用锐针松解皮肤与深层组织之间退缩瘢痕的纤维带。该手术需要分2期进行，间隔6至12个月。在第一期，注入3.0至10毫升脂肪。在第二期再注入3至5毫升。3例患者在最后阶段在局部麻醉下进行了瘢痕切除。
所有10例患者均实现了美学和功能改善，在长期随访（平均21.3个月）中对结果满意。
脂肪移植被证明是一种安全、微创且有效的手术，可用于治疗气管造口术瘢痕的功能和美学问题。它可被视为大型开放手术的有效替代方法。
