Q: Dr. Eppley, I am interested in trach scar revision. I have a very ugly scar from a tracheotomy tube and am interested in knowing what my options are in terms of eliminating or reducing the appearance. The tube was removed mid-September of 2014. My doctors suggested waiting some months for everything to heal before considering any cosmetic surgery.There may also be some internal scarring, which seems to be inhibiting normal swallowing somewhat. What type of trach scar revision do you recommend?
A: Tracheostomy scars can be reduced/improved in appearance but never completely eliminated. Given that you are six months from the tube being removed, the treatment of the trach scar could be done any time in my opinion. The only reason to wait any longer, in any type of scar revision, is if one thought that more time had a chance to make it improve enough that surgery should not be needed. Because most tracheostomy scars are depressed, I prefer the use of a small dermal fat graft to fill the defect at the same time as revision of the skin scar. This can also release the tether that is often seen when swallowing. This converts a round depressed scar into a flat linear scar.
Dr. Barry Eppley
Q: Dr. Eppley, I was born pre mature and have a bad tracheostomy scar that I really want improved. After reading your website I can see that you are a extremely talented surgeon with lost of practice in this area. I have attached two pictures, one where the neck is stretched and one where Im looking straight forward. Can you please tell me what is possible to do here, and what results I can expect?
A: What you have is a vertically oriented tracheostomy scar with a central depression. The best way to treat that type of trach scar would be total excision and contracture release, interpositional dermal-fat graft and linear or partial broken line skin closure. You most certainly should be able to substantially narrow the scar line and even out its contour with the surrounding unscarred skin. In short, there is a lot of room for improvement in your tracheostomy scar. The one negative to your trach scar is that it is vertically oriented, completely perpendicular to the natural horizontal relaxed skin tension lines of the neck. This natural anatomic violation will make any neck scar revision more prone to secondary widening than if the initial scar was horizontal in orientation.
Dr. Barry Eppley