Tracheostomy

Tracheotomy is one of the oldest, most known, and performed procedures in whole general surgery. Its aim is to get over different obstructions that hamper the air to reach the lungs through the natural way. Nowadays, tracheotomy has three major indications: (1) to get over a severe obstruction of the upper airways; (2) to protect and clean lower airways; and (3) to support ventilation. In Italian traditional surgery, we distinguish: Tracheostomy: when we suture the whole tracheal wall to the skin; Tracheotomy: when we suture only the tracheal external wall to the skin; and cricotomy; when we cut the cricothyroid membrane in an emergency. On the contrary, in the literature, the authors usually distinguish: Overhystmic tracheotomy: when the opening of the trachea is performed above the thyroid isthmus (1–2° ring); Transisthmic tracheotomy: when the opening of the trachea is performed through the thyroid isthmus; Underisthmic tracheotomy: when the opening of the trachea is performed under the thyroid isthmus. The first step is the skin incision with horizontal cervical cut usually in the middle point between cricoid and jugular; we dissect subcutaneous tissue, we open prethyroid muscle in the middle, we cut and open cervical bands, we move or cut thyroid isthmus, we point out a stripping tracheal wall removing any tissue adherence, and finally, we cut the trachea with a vertical cut on the midline. Regarding the shape of the tracheal wall opening, in children, we prefer a linear incision of the tracheal wall without the sacrifice of tracheal tissue. We distinguished early and late complications. The early complications are bleeding, subcutaneous emphysema, infections, and accidental decannulation. The late ones are granulations and suprastomal collapse; stenosis or granulations of the tip of the cannula; granulations of the stoma which may complicate the cannula introduction; Innominate artery fistula (rare); Lower respiratory tract infections; Accidental decannulation with obstruction; and Wrong-way creation during the introduction.