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Combination tracheostomy
burns 33 (2007) 398
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/burns
Letter to the Editor
Combination tracheostomy Sir, Tracheostomy using open or percutaneous techniques has become a routine procedure [1]. Many severely burnt patients requiring tracheostomy may have burnt neck skin, considerable oedema and neck swelling and engorged neck veins. These patients are difficult for both open and percutaneous techniques. We found that a combination technique using elements of both procedures has proved useful in these cases. If the neck skin is spared or has a superficial burn that will heal without grafting then an initial small transverse incision is used. In deep dermal or full thickness burns it is ideal to graft the area before performing a tracheostomy but otherwise a vertical incision in the burnt skin can be used as this will be eventually replaced with a graft. Following infiltration with dilute adrenaline, through the incision tissues are separated in the midline almost blindly (the oedema can make tissue retraction almost impossible) until the trachea can be palpated with a finger. Thereafter a percutaneous technique is used allowing the trochar to be accurately inserted into the trachea. A bronchoscope can also be used to check the position if desired. Where the number of performed tracheostomies are relatively low, and where there is no ready access to ENT
surgery this technique has worked well. However it is essential that a surgeon capable of performing an open procedure should be available if problems arise.
reference
[1] Gravvanis AI, Tsoutsos DA, Iconomou TG, Papadopoulos SG. Percutaneous versus conventional tracheostomy in burned patients with inhalation injury. World J Surg 2005;29(12):1571–5.
Reika Taghizadeh* Philip M. Gilbert Queen Victoria Hospital, East Grinstead, United Kingdom *Corresponding author. Tel.: +44 781 400 4646 E-mail address: [email protected] (Reika Taghizadeh) 0305-4179/$30.00 # 2006 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2006.08.003
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/burns
Letter to the Editor
Combination tracheostomy Sir, Tracheostomy using open or percutaneous techniques has become a routine procedure [1]. Many severely burnt patients requiring tracheostomy may have burnt neck skin, considerable oedema and neck swelling and engorged neck veins. These patients are difficult for both open and percutaneous techniques. We found that a combination technique using elements of both procedures has proved useful in these cases. If the neck skin is spared or has a superficial burn that will heal without grafting then an initial small transverse incision is used. In deep dermal or full thickness burns it is ideal to graft the area before performing a tracheostomy but otherwise a vertical incision in the burnt skin can be used as this will be eventually replaced with a graft. Following infiltration with dilute adrenaline, through the incision tissues are separated in the midline almost blindly (the oedema can make tissue retraction almost impossible) until the trachea can be palpated with a finger. Thereafter a percutaneous technique is used allowing the trochar to be accurately inserted into the trachea. A bronchoscope can also be used to check the position if desired. Where the number of performed tracheostomies are relatively low, and where there is no ready access to ENT
surgery this technique has worked well. However it is essential that a surgeon capable of performing an open procedure should be available if problems arise.
reference
[1] Gravvanis AI, Tsoutsos DA, Iconomou TG, Papadopoulos SG. Percutaneous versus conventional tracheostomy in burned patients with inhalation injury. World J Surg 2005;29(12):1571–5.
Reika Taghizadeh* Philip M. Gilbert Queen Victoria Hospital, East Grinstead, United Kingdom *Corresponding author. Tel.: +44 781 400 4646 E-mail address: [email protected] (Reika Taghizadeh) 0305-4179/$30.00 # 2006 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2006.08.003