Page 148 - Manual of Equine Field Surgery

144 HEAD AND NECK SURGERIES

site to minimize the tension on the tracheal

mucosa-skin junction during subsequent closure.

Bleeding is controlled with hemostat application

and or ligation if necessary. Subcutaneous tissue

may be sutured to the peritracheal fascia to

decrease dead space.

A midline and two paramedian incisions are

made 15 mm on each side of midline in the

exposed tracheal rings (Figures 24-2 and 24-3).

Care should be taken to start on midline and to

Tracheostomy avoid incising the mucosa. The rectangular seg-

incision site
ments of tracheal cartilage that are created are

carefully dissected free of mucosa. The mucosa is

desensitized with topical application of local anes-

thetic solution and incised in a double-Y-pattern.

Stay sutures are placed to align and prevent retrac-

tion of the mucosa. The mucosa is then apposed

to the skin using No. 2-0 PDS and a simple inter-

rupted pattern. Care should be taken to close all

gaps between mucosal edges or between mucosa
Figure 24-1 Incision site for tracheostomy, just

caudal to the first tracheal ring. and skin. The remaining skin incision, proximal

A

Figure 24-2 Ventral view of the neck illustrat-

ing tracheostomy procedure. A, Dotted lines show-

ing proposed incision lines through tracheal

cartilage only. B, After incising through cartilage

and removal of the first four tracheal sections.

C, After removal of all tracheal sections. Dotted

line shows proposed double- Y incision in tracheal

mucosa. D, Finished tracheostomy showing tra-

cheal mucosa sutured to skin.

B

D

c