Tracheotomy Surgical Technique

Fig. 7.1

Identification of skin landmarks before incision

The surgeon has to identify (Fig. 7.1):

1.

Notch of thyroid cartilage
2.

Cricoid cartilage
3.

Skin incision line
4.

Suprasternal notch

7.1.2 1st Surgical Step: Incision of the Skin

Fig. 7.2

Ideal triangle formed by cricoid cartilage, suprasternal notch and SCM

7.1.2.1 Anatomical Key Points (Fig. 7.2)

Cricoid cartilage
Suprasternal notch
Sternocleidomastoid muscle (SCM)

7.1.2.2 Pearls and Potential Complications

The surgeon normally performs a 3–4 cm horizontal skin incision (Fig. 7.3). The incision is usually placed at least two fingerbreadths below the cricoid cartilage in an inverse triangular space formed by the cricoid cartilage (red line) at the base, the suprasternal notch at the apex and SCM in the lateral border (yellow and green line). The identification of the anterior jugular vein on the skin is useful to prevent its accidental section. The incision must involve the skin, subcutaneous tissue and platysma muscle until exposure of SLDCF (Fig. 7.4).