TRACHEOTOMY

 
 

 

index

 

table of contents

 

my operations

 

How I did It?

 

 

 

 

Operative Technique

 

Ø      Patient supine on General Anesthesia

Ø      Folded sheet placed underneath the shoulders, neck extended

Ø      Asepsis and antisepsis

Ø      Sterile drapes placed

Ø      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

Ø      Sternohyoid muscle exposed

Ø      Hemostasis with electrocoagulation

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

Ø      Cricoid cartilage and first tracheal ring visualized and preserved

Ø      Capsule of the thyroid gland exposed and divided

Ø      Thyroid isthmus identified and elevated from the trachea

Ø      Isthmus divided between clamps and suture ligated with chromic 4.0

Ø      2nd and 3rd tracheal rings identified

Ø      Hemostasis

Ø      2nd ring elevated by a hook

Ø      transverse incision made just above the 2nd ring

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

Ø      Edges of trachea retracted using hooks

Ø      Tracheotomy tube inserted carefully while anesthesiologist pull endotracheal tube

Ø      Aspirate mucous using suction catheter

Ø      Attach anesthesia line to the tracheotomy tube

Ø      Hemostasis

Ø      Sternohyoid muscles reapproximated using interrupted vicryl 4.0

Ø      Platysma reapproximated using interrupted vicryl 4.0

Ø      Skin closed loosely with interrupted 4.0 nylon sutures

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

Ø      Fix tracheotomy tube with tapes