TRACHEOSTOMY

Operative Technique

Patient supine on General Anesthesia

Folded sheet placed underneath the shoulders, neck extended

Asepsis and antisepsis

Sterile drapes placed

Incision made vertically beginning at the level of cricoid and continuing caudal direction 4 – 5cm. Incision carried from skin through subcutaneous tissue and platysma muscle directly over the midline of the trachea

Sternohyoid muscle exposed

Hemostasis with electrocoagulation

Strap muscles elevated and vertical incision made down the midline separating the two muscles. Incision carried down to the upper trachea

Cricoid cartilage and first tracheal ring visualized and preserved

Capsule of the thyroid gland exposed and divided

Thyroid isthmus identified and elevated from the trachea

Isthmus divided between clamps and suture ligated with chromic 4.0

2^nd and 3^rd tracheal rings identified

Hemostasis

2^nd ring elevated by a hook

transverse incision made just above the 2^nd ring

2^nd ring divided with the scalpel, (and also the third ring if necessary)

Edges of trachea retracted using hooks

Tracheotomy tube inserted carefully while anesthesiologist pull endotracheal tube

Aspirate mucous using suction catheter

Attach anesthesia line to the tracheotomy tube

Hemostasis

Sternohyoid muscles reapproximated using interrupted vicryl 4.0

Platysma reapproximated using interrupted vicryl 4.0

Skin closed loosely with interrupted 4.0 nylon sutures

Tracheotomy tube hold in place by silk 2.0 sutures in two places

Fix tracheotomy tube with tapes