Revision of the Retracted Posttracheostomy Scar by Anatomical Restoration; Four Layer Closure

Most tracheostomy scars are depressive and adherent to the underlying trachea, which causes up and down movement when swallowing. This tracheocutaneous tethering causes discomfort, pain, dysphagia, and bad appearance. A tracheocutaneous fistula may be accompanied. Here, we present a new method for reconstructing a tracheostomy scar deformity with tracheocutaneous tethering: layer-by-layer restoration of the anatomical structure with a subcutaneous fat tissue blanket. The scar tissue was fully excised, with the associated skin and subcutaneous tissue. The bilateral strap muscles around the scar were dissected proximally and distally and approximated to the midline, secured without tension. Bilateral platysma muscle flaps cover them firmly. The subcutaneous tissue around the incision margin, which included the superficial cervical fascia was elevated to form a fat blanket, closed transversely. The skin was closed after confirming the absence of retraction upon swallowing. From 2010 to 2018, 10 patients with tracheocutaneous tethering and one patient with tracheocutaneous fistula underwent surgery. All patients were functionally and aesthetically satisfied with the results. The only complication was a hypertrophic scar in one patient, which was managed with a triamcinolone injection. An anatomical layer-by-layer restoration with a fat blanket provided consistent, satisfying results for correcting tracheostomy scar deformities without using additional tissue. This simple method was effective for reconstructing tracheocutaneous tethering.