Correction of the depressed, retracted, post-tracheostomy scar.

Many methods have been developed for the correction of tracheal tug and scar depression. Early authors did well in correcting scar depression, but the correction of tracheal tug was more difficult. One method used to limit scarring is intralesional steroid injections. Repeated steroid injections inhibit healing, which could also limit skin-to-trachea adhesions. Carlson et al. were the first to advocate the use of an alloplastic barrier to prevent tracheal tug. Lyophilized dura has been used for several years by various surgical specialties. Microscopic studies have shown no host response; in fact, fibroblastic ingrowth is common. The use of alloplastic dura ensures that there is no contracture between the trachea and the skin, thus preventing tracheal tug. Alternatives to this method include soft-tissue procedures (as previously mentioned) to add bulk and then triamcinolone acetonide injections to prevent adherence and scarring. It is important to treat each case individually and to provide treatment that is best suited to the patient's needs. The method used in these case reports not only eliminates scar depression, but prevents tracheal tug as well.