The multidisciplinary strategy to severe neck contracture and complex post-tracheostomy tracheal stenosis: A case report

RATIONALE: Complex post-tracheostomy tracheal stenosis (PTTS), characterized by cartilage destruction and tracheomalacia, is a severe, rare complication in burn patients. Concomitant severe postburn neck contractures impair airway access, rendering conventional treatments (e.g., tracheal resection and endoscopic interventions) challenging and necessitating multidisciplinary strategies. PATIENT CONCERNS: A 49-year-old male with a 2-year history of banana oil-induced burns presented with exertional dyspnea (modified Medical Research Council Grade 3). He had failed prior endoscopic interventions and refused surgical tracheal resection. Severe neck contractures limited mobility and airway access. DIAGNOSES: Complex PTTS (Cotton-Myer Grade III, 6-mm luminal narrowing, cartilage destruction, and tracheomalacia) confirmed via computed tomography and bronchoscopy; severe postburn neck contracture (microstomia, fixed flexion deformity) on physical exam. INTERVENTIONS: A two-stage multidisciplinary approach was implemented: neck contracture release with a pre-expanded 18 × 10 cm supraclavicular artery perforator flap; rigid bronchoscopy-guided placement of a 10 × 50 mm hourglass-shaped silicone stent. OUTCOMES: Postoperatively, the patient regained normal mastication, phonation, and respiration by the fourth week. At the 4-year follow-up, he maintained tracheal patency (modified Medical Research Council Grade 1), had restored neck function, and experienced no stent complications. He declined further surveillance. LESSONS: Multidisciplinary collaboration is critical for managing complex PTTS with severe postburn neck contractures in patients unsuitable for surgery. Pre-expanded supraclavicular flaps enable safe airway interventions, while hourglass stents effectively maintain patency. Prospective studies are needed to standardize such protocols.