Tracheotomy is the operation of dissection of the trachea for insertion into the lumen of its special metal cannula. It is indicated with difficulty breathing due to narrowing of the lumen of the trachea or larynx ( stenosis ). Distinguish between the upper, lower and middle tracheotomy in relation to the isthmus of the thyroid gland. In connection with the anatomical age, the lower one is preferred in children, and the upper tracheotomy in adults.
Preparing for surgery. The patient is laid on his back with his head thrown back. Under the shoulders put a cushion, so that the neck does not sink and access to the trachea was more convenient. Special tools require single-tooth sharp hooks for the trachea, blunt hooks, a dilator of the trachea and tracheotomy cannulas (see Otorhinolaryngological Instrumentation).
Upper tracheotomy: 1 - the introduction of a tracheotomy tube; 2 - tracheotomy tube inserted.
Technique of operation (Fig.). Infiltration anesthesia is made with 30 ml of 0.5-1% novocaine solution with the addition of 0.1% solution of adrenaline (1 drop for each 1 ml of novocaine solution). The incision is strictly along the midline of the neck from the protrusion of the thyroid cartilage (Adam's apple) down 4-6 cm. Dissect the skin, subcutaneous fat, aponeurosis, bluntly divide the white line between the sternum-hyoid muscles. Muscles push apart with dull hooks. At the cricoid cartilage on the lower edge of it cut the fascia by a transverse incision, pull the isthmus of the thyroid gland downwards. Fix the trachea with sharp single-tooth hooks on both sides and cut 2-3 tracheal rings with a scalpel from the bottom up. In the section enter the expander of the Tissue and then the cannula. On a cut superimposed seams. Follow the thoroughness of the hemostasis.The
The lower tracheotomy is more difficult and dangerous, since the trachea lies deeper and a dense network of venous vessels is located on it. Cutaneous incision with a lower tracheotomy is done from the cricoid cartilage to the jugular notch. The isthmus of the thyroid gland is pulled upward.
One of the variants of the operation is transverse tracheotomy: the trachea is opened by a transverse incision along the lower edge of the first ring and the cannula is inserted.
If the tracheotomy fails to bypass the sharply enlarged thyroid gland, then the isthmus crosses between two superimposed ligatures or haemostatic clamps. The dissection of the trachea at the level of the ruptured neck of the thyroid is called the average tracheotomy.
If asphyxia occurs during tracheotomy, camphor or caffeine or lobelia is injected. In these cases, pre-open the trachea and only then proceed to artificial respiration. Complications of tracheotomy - bleeding, subcutaneous emphysema , aspiration pneumonia . Subcutaneous emphysema is recognized by the characteristic sensation of crunches during palpation of the skin, swelling. In this case, you need to remove some of the sutures in the wound and loosen the bandage.
Restoration of the lumen of the trachea and larynx makes possible a decanulation, i.e., removal of the tube from the trachea, followed by wound healing . If you need to keep a hole in the trachea constantly, make a tracheostomy, hemming the skin along the edges of the hole in the trachea to the mucous membrane. Then, after removing the tube, the hole in the trachea (tracheostomy) is preserved.
Care for a tracheotomized patient consists in monitoring the lumen of the tube and the condition of the skin around the cannula. Several times a day, the inner tube of the cannula is removed and its clearance cleared. For this, a piece of gauze bandage is passed through the tube and moved to either side. The tube is then boiled and reinserted into the outer tube of the cannula located in the trachea. The skin around the tube is rubbed with alcohol, smeared with fat ( emulsion , oil), and under the tube is put a napkin consisting of 4-6 layers of gauze, shaped like a rectangle, cut to half from top to bottom so that each of the two formed bands of gauze could be placed from both sides of the tracheotomy cannula. The cannula can not be completely removed from the trachea before 5-7 days later, because the opening of the trachea is immediately narrowed and the cannula without a dilator can not be inserted.