Post-Tracheostomy Care: Addressing Wound Healing and Future Risks

Q: Post-Tracheostomy Care: Addressing Wound Healing and Future Risks

Hello： 1. The tracheostomy wound will gradually heal on its own over time, and it is generally covered with a scarf for both aesthetic and practical purposes. 2. It may not necessarily be a complication of the tracheostomy. Older patients often have reduce

What special considerations should be taken after the wound of a tracheostomy patient has healed?

Hello, thank you for your previous response.
My mother has had her tracheostomy tube removed for over three months now, and she is recovering well.
However, the healing wound on her neck has turned into a small deep hole, and the skin inside is healing.
My mother is worried that others might be scared if they see it, so she is covering the hole with skin-colored breathable tape.
Will that deep hole always be there, or will it gradually heal on its own?
Additionally, about a month ago, my mother accidentally choked on saliva or phlegm and almost couldn't breathe.
After a bout of coughing, she was fine, but it seems she can't laugh too hard for too long; her laugh sounds a bit strange, and it feels different from before her tracheostomy.
That incident of choking was really frightening for me, and although it hasn't happened again since, I can't help but worry about what would happen if she choked again while home alone.
Is this a complication from the tracheostomy? How can we prevent such incidents from happening?
Furthermore, since my mother is already 69 years old, if she needs surgery in the future (which I certainly hope doesn't happen), the anesthesiologist who initially performed her surgery told me that I must inform the doctors about her tracheal narrowing.
If it is known that her trachea is narrowed and intubation is not possible, what should be done during general anesthesia? I apologize for the many questions.
Thank you.

Eva, 20~29 year old female. Ask Date: 2006/07/29

Dr. Zhuang Ziyi reply Pulmonology

Hello:
1.
The tracheostomy wound will gradually heal on its own over time, and it is generally covered with a scarf for both aesthetic and practical purposes.

2.
It may not necessarily be a complication of the tracheostomy.
Older patients often have reduced elasticity in the tracheal cartilage, which can lead to dynamic tracheal collapse during exertion, resulting in abnormal voice changes.
If the patient has a history of smoking or has previously developed tracheal tumors due to the tracheostomy, this may be more pronounced.
Currently, there is no treatment for dynamic tracheal collapse; however, a temporary use of a mask-type positive pressure ventilator may help alleviate symptoms.

3.
It is difficult to assess the severity and extent of tracheal narrowing in the patient.
A definitive diagnosis typically requires bronchoscopy or a computed tomography (CT) scan to reconstruct a three-dimensional image of the trachea.
If there is significant narrowing that necessitates intubation, only a smaller diameter endotracheal tube can be used, which may increase respiratory resistance and could complicate extubation in the future.

4.
Reference: Murray and Nader’s Textbook of Respiratory Medicine, 4th ed.
Respiratory Medicine, 3rd ed.

Respectfully, Dr.
Zhuang Ziyi

Reply Date: 2006/07/29

More Info

Post-tracheostomy care is crucial for ensuring proper healing and minimizing future risks. It’s great to hear that your mother has been recovering well after her tracheostomy was removed. However, the concerns you have regarding the healing of the wound and the potential complications are valid and important to address.

Firstly, regarding the small deep hole that has formed at the site of the previous tracheostomy, it is not uncommon for such wounds to take time to heal completely. The healing process can vary significantly from person to person, especially in older adults. The skin inside the hole may appear to be healing, but the outer layer of skin might take longer to close completely. In many cases, these types of wounds can gradually fill in and close over time, but this can depend on factors such as blood circulation, nutrition, and overall health. It’s advisable to keep the area clean and protected, as your mother is doing with the skin-colored tape. However, it would be best to consult with her healthcare provider to monitor the wound and discuss whether any additional treatment is necessary.

As for the incident where your mother was nearly choked by saliva or phlegm, this can happen post-tracheostomy, especially if the airway has not fully returned to its normal function. After a tracheostomy, some patients may experience changes in their swallowing and coughing reflexes, which can lead to difficulties in managing secretions. To help prevent choking, it’s important for her to stay hydrated, as this can thin mucus and make it easier to manage. Additionally, practicing safe swallowing techniques and possibly working with a speech therapist could be beneficial. If she experiences difficulty breathing or choking again, it’s crucial to have a plan in place, such as knowing how to perform the Heimlich maneuver or having emergency contacts readily available.

Regarding her voice changes and the sensation of not being able to laugh as before, this could be related to the changes in her airway and vocal cord function after the tracheostomy. It’s not unusual for patients to experience some alterations in their voice quality after such procedures. If this continues to be a concern, a consultation with an ear, nose, and throat (ENT) specialist may provide further insights and potential therapies to improve her vocal function.

Concerning future surgeries, it’s essential to inform any medical professionals about her history of tracheostomy and any complications related to her airway. If her trachea is narrowed, this could pose challenges for intubation during general anesthesia. An anesthesiologist can discuss alternative methods for airway management, such as using a smaller tube or considering regional anesthesia if appropriate. It’s crucial to have these discussions well in advance of any planned procedures to ensure her safety.

In summary, while your mother’s recovery seems to be progressing, ongoing monitoring of her wound and airway function is essential. Regular follow-ups with her healthcare provider will help address any concerns and ensure that she receives the appropriate care. Encourage her to maintain open communication with her medical team about any new symptoms or worries she may have. With proper care and attention, many of the issues you’ve raised can be managed effectively.

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