Is It Too Late To Have A Tracheostomy Scar Revision Done?

Q:  I was just wondering if I am a good candidate for a tracheostomy scar revision. I had a tracheostomy back in 2005 and never knew that a revision surgery was possible until recently. I am really self-conscious of this hole in my neck. Plus it constantly reminds of why it is there in the first place. (a car accident)

A: Tracheostomies that remain in for any extended period of time (weeks to months) will often leave a depressed scar once they are removed and heal. This is the result of a phenomenon known as pressure atrophy of the subcutaneous fat. The pressure of the tube and the subsequent scar that it creates results in fat loss and tethered or scarring down of the skin edges. Tracheostomies wounds are now closed after tube removal and are allowed to heal in on their own.

Some initial tracheostomy scars may look depressed or indented but may ‘fill out’ as healing progresses to an acceptable level. This is why I don’t do tracheosotomy scar revision in the first six months after tube removal unless the wound has real trouble healing. Conversely, it is never too late to revise the depressed neck scar.

Many tracheostomy scars can be improved by simple scar revision. Others may require some fat volume restoration with scar revision. I prefer a small dermal-fat graft to replace the lost tissues between the scar overlying the trachea and the underside of the skin. Even a small graft, 2.5 cm x 1 cm, can be really helpful. There is no substitute for your own natural fat for small areas of tissue filling. The graft can be easily harvested from old scars almost anywhere on the body.

Dr. Barry Eppley