Surgeon(s): ***

‍Assistant Surgeon(s):  ***

‍Preoperative Diagnosis: ***

‍Postoperative Diagnosis: Same

‍Procedure(s): ***

‍Anesthesia: General

‍Implants: None

‍Specimen:***

‍Drains: None

‍Fluids: See anesthesia record

‍EBL: Minimal

‍Complications: None

‍Counts:  Correct x2

‍Indications: ​***

‍Findings: As expected

‍Procedure in Detail:

‍The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail.  The patient was transferred to the operating room by the anesthesia team.  The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures.  A time-out was performed and the procedure began.

number #15 blade was used to create a horizontal incision extending 3 cm inferiorly from the lower border of the cricoid through dermis. Bovie dissection (with effort to avoid anterior jugular veins) was employed to remove fat overlying the strap muscles by grasping the fat with Allis clamps and lateral retraction of the skin edges. The strap muscles were grasped with Allis clamps and pulled laterally to identify the midline with hemostat (with bovie) separation of the straps in the midline. Below the cricoid and above the thyroid isthmus was identified by inspection and palpation and then opened with Bovie cautery. With tips of a hemostat directed toward the trach, blunt dissection with the tips of the hemostat identifed the anterior tracheal wall. The hemostat was redirected inferiorly to separate the posterior aspect of the thyroid isthmus from the trachea. The hemostat (kelly clamp) was then used to clamp across the isthmus off the midline with a second hemostat placed opposite. Bovie cautery separated the isthmus. The anterior tracheal wall was further cleaned of overlying soft tissue with Kitners. The tracheal rings were identified. The anesthesiologist was requested to deflate the cuff of the ETT. A small hemostat (with tips closed) was directed toward the trachea and pushed through the membranous ring (between 2nd and 3rd cartilaginous rings). The hemostat was then manipulated to direct a #15 blade to make a horizontal cut in the membranous trachea. Vertical lateral cuts were made on either side of the opening inferiorly through the third cartilaginous ring. An inferiorly based Bjork flap was created by suturing the third cartilaginous ring to the skin (one midline suture). The endotracheal tube was partially removed, so that the tip was just superior to the tracheotomy site. The tracheostomy tube with obturator was then placed. The inner canula was placed, and placement of the tube was confirmed with CO2 return on the anesthesia monitor. Endotracheal tube removed. Mastisol and steri-strips used to secure stay suture to skin.

The patient's face was then cleaned and the posterior pharynx was suctioned. An OG tube was used to suction out the contents of the stomach. Tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.

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