Date of Surgery -
PREOPERATIVE DIAGNOSIS:
1. Acute respiratory failure with prolonged ventilator dependence.
POSTOPERATIVE DIAGNOSIS:
1. Acute respiratory failure with prolonged ventilator dependence.
Surgeon - Dr. Luk / Dr. Tran
Assistant Surgeon -
Anesthesia - General anesthesia
Estimated Blood Loss - Minimal
Complication - none
Findings - normal anatomy
Specimen - none
OPERATION PERFORMED:
1. Open tracheostomy, modified flap technique, 8.0 mm Shiley DCT tracheostomy tube placement.
INDICATIONS:
The patient presents with multiple medical issues including acute prolonged respiratory failure with ventilator dependence, and failure to wean from the ventilator. The patient is in need for long-term ventilator access via tracheostomy. The need for the procedure, details of the procedure, options, expected benefits, risks and limitations were discussed with the patient's family members, and all questions were answered. Informed consent was obtained.
PROCEDURE IN DETAIL:
The patient was taken to the operating room and was placed in the supine position. The patient's anterior neck was prepped with Betadine and draped in sterile towels and drapes. A transverse incision was made at the anterior neck approximately 3 cm above the sternal notch. The deeper dissection was continued with electrocautery, dissecting through the underlying subcutaneous tissue until the platysma was identified. The platysma was incised and dissected from the underlying strap muscles. The strap muscles were divided in the midline to expose the trachea. Thyroid isthmus tissue was divided with 2-0 silk suture ligatures. An inverted U-shaped incision was made on the anterior trachea at the second tracheal ring to create a tracheal flap. This was secured to the inferior platysmal flap with 2-0 Vicryl suture. The endotracheal tube was withdrawn slowly under visualization and a new 8.0 mm tracheostomy tube was placed into the trachea and the cuff inflated. Adequate ventilation was noted with confirmation of end-tidal CO2. Tracheobronchial suctioning was performed with a suction catheter and hemostasis was checked. The wound was packed with Surgicel and the external flange of the tracheostomy secured to the skin with 2-0 nylon suture and the tracheostomy straps applied. All sponge and needle counts were reported as correct. The patient tolerated the procedure well and was returned to recovery in stable condition.