Kurt Yazar Sevgi, Yüce Erkan, Serin Merdan, Yazar Memet, Gül Zeliha, Irmak Fatih, Şirvan Serhat Selami
Plastic, Reconstructive and Aesthetic Surgery Clinic, Kirikkale High Education Hospital, Kirikkkale.
Plastic, Reconstructive and Aesthetic Surgery Clinic, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
Ann Plast Surg. 2018 Sep;81(3):311-315. doi: 10.1097/SAP.0000000000001531.
The goals of tracheostomy scar revision are filling of the depressed area, providing easy sliding of skin over the trachea. There are various techniques described to correct this situation. In this article, a modification of split sternocleidomastoid (SCM) muscle flap used in the correction of posttracheostomy defects is described.
Thirteen patients who had depressed scars after tracheostomy are included in this study. The mean patient age was 44 years (range, 27-56 years). All patients who suffered from tracheal tug, dysphagia, and bad appearance are included in the study. The area with the depressed scar is de-epithelialized after incising around the depression. Bilateral SCM muscles are split in the coronal plane toward superior half of the muscle while leaving the posterior part of the muscle attached to the bone. After elevation, both SCM muscle flaps are overlapped in the midline.
The mean follow-up period of the patients was 11 months (range, 5-20 months). Tracheal tug and dysphagia complaints were resolved in all patients. The depressed area due to the scar was either reduced or completely recovered in all the patients. Apart from 1 hematoma case, none of the early or late complications such as infection, wound dehiscence, skin necrosis, seroma, recurrence, or neck contracture was seen.
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.
气管造口瘢痕修复的目标是填充凹陷区域，使皮肤能在气管上轻松滑动。已有多种技术用于矫正这种情况。本文描述了一种改良的胸锁乳突肌（SCM）肌瓣，用于矫正气管造口术后缺损。
本研究纳入了13例气管造口术后有凹陷瘢痕的患者。患者平均年龄为44岁（范围27 - 56岁）。所有患有气管牵拉、吞咽困难和外观不佳的患者均纳入研究。在凹陷周围切开后，将凹陷瘢痕区域的上皮去除。双侧胸锁乳突肌在冠状面向上半部分劈开，同时保留肌肉后部附着于骨骼。掀起后，将两侧胸锁乳突肌瓣在中线处重叠。
患者平均随访期为11个月（范围5 - 20个月）。所有患者的气管牵拉和吞咽困难症状均得到缓解。所有患者瘢痕所致的凹陷区域均有所减小或完全恢复。除1例血肿病例外，未观察到感染、伤口裂开、皮肤坏死、血清肿、复发或颈部挛缩等早期或晚期并发症。
我们认为，这项技术在功能和美学方面都能取得令人满意的效果，可安全用于气管造口术后形成的凹陷瘢痕以及因该手术导致的功能障碍的治疗。
