A tracheotomy is a surgical dissection of the trachea for introduction into the lumen of its special metal cannula. Shown when breathing difficulties due to the narrowing of the lumen of the trachea or larynx (stenosis). There are top, bottom and middle tracheotomy in relation to the isthmus of the thyroid gland. In connection with anatomical age peculiarities of children preferred the bottom, and in adults - top tracheotomy.
Preparation for surgery. Patient is placed on his back with head thrown back. Under shoulders put a roller to neck sinks and access to the trachea was more convenient. Of special tools are required odnopolie sharp hooks for trachea, stupid hooks, trachea dilator and tracheotomies cannula (see Otorhinolaryngology tools).

Top tracheotomy: 1 - introduction tracheotomies tube; 2 - tracheotomies tube is introduced.

Equipment operation (Fig). Done infiltration anesthesia 30 ml of 0.5-1 % solution novokaina with the addition of 0.1% solution of epinephrine (1 drop each 1 ml solution novokaina). The incision is strictly on the midline of the neck from the point of thyroid cartilage (the Adam's Apple) down to 4-6 cm Cut through the skin, subcutaneous tissue, the aponeurosis, stupid share by white line between the sternum-sublingual muscles. Muscles pushing the blunt hooks. The cricoid cartilage on the lower edge of netscout cross-section of the fascia, retard the isthmus of a thyroid gland at the bottom. Fix the trachea acute odnosima hooks on both sides and cut 2-3 rings trachea with a scalpel from the bottom up. In the section introducing the extender trusso and then the cannula. The incision is stitched up. Follow careful hemostasis.
Lower tracheotomy more difficult and dangerous, as the trachea is deeper and there is a dense network of venous vessels. Skin incision in the lower tracheotomy do from the cricoid cartilage to the jugular notch. The isthmus of the thyroid gland pull up.
One option is to cross tracheotomy: the trachea open cross-section along the bottom edge of the first ring and enter the cannula.
If the tracheotomy cannot around sharply enlarged thyroid gland, then it crossed the isthmus between two superimposed pre-ligatures, or styptic clips. Dissection of the trachea at the level of rugged isthmus of the thyroid gland is called average tracheotomy.
At occurrence of asphyxia during tracheotomy enter camphor or caffeine, lobelias. In these cases, pre expose the trachea and only then begin artificial respiration. Complications tracheotomy - bleeding, subcutaneous emphysema, aspiration pneumonia. Subcutaneous emphysema is recognized by the typical sense of perustuvia with palpation of the skin, swelling of the. In this case it is necessary to remove a part of seams in the wound and loosen the bandage.
The restoration of the lumen of the trachea and larynx allows decanulation, i.e. remove the tube from the trachea and subsequent healing of wounds. If you want to save an opening in the trachea constantly, doing a tracheostomy, placing the skin around the edges of the hole in the trachea to the mucosa. Then after removing the tube opening in the trachea (tracheostomy) is saved.
Care tracheotomies patients is to control the lumen of the tube and condition of the skin around the cannula. Several times a day inner tube cannula is removed and its clearance is procesada. To do this in a tube miss a piece of gauze bandage and move it in that and other party. Then the tube is boiled and again inserted into the outer tube cannula, which is located in the trachea. The skin around the tube is wiped with an alcohol lubricated with grease (emulsion, oil), and for the pipe should be given the cloth consisting of 4-6 layers of gauze, with rectangular shape, cut to half from top to bottom so that each of the two formed of strips of gauze could be put on both sides tracheotomies cannula. The cannula be removed completely from the trachea earlier than 5-7 days it is impossible, as the hole of the trachea immediately narrows and enter the cannula back without extender will not succeed.