Delayed tracheal injury following total thyroidectomy: case report and literature review.

A 51-year-old woman developed extensive subcutaneous emphysema on postoperative day 7 following total thyroidectomy with central lymph node dissection for thyroid cancer, indicating delayed tracheal injury. Emergency surgery revealed rupture of inter-tracheal ring ligaments and connective tissue, resulting in a necrotic 3 × 2 cm wound with purulent exudate. Necrotic tissue was debrided until viable bleeding margins were achieved. Infection was controlled using vacuum sealing drainage (VSD) with continuous negative-pressure drainage and anti-infective therapy. The tracheostomy tube was subsequently inserted, replaced, and eventually removed without incident, and the patient recovered fully before discharge. This rare complication highlights impaired tracheal blood supply as a key etiology for necrosis. Timely diagnosis and staged surgical intervention are critical for managing post-thyroidectomy tracheal injuries.