da với đường được chia cắt bằng kéo từ các mô xung quanh xuống để mở khí quản. Đường được tách ra từ khí quản với một con dao (hình 26-11). • sụn loại bỏ là không cần thiết. Nếu sụn bị loại bỏ, số tiền được tối thiểu. • Có những kỹ thuật khác nhau để đóng các lỗ rò. Bất kể kỹ thuật, tràn khí dưới da phải được ngăn chặn. | 594 Surgical Atlas of Pediatric Otolaryngology The skin with the tract is dissected with scissors from the surrounding tissue down to the opening in the trachea. The tract is separated from the trachea with a knife Figure 26 11 . Cartilage removal is generally unnecessary. If cartilage is removed the amount should be minimal. There are different techniques for closure of the fistula. Regardless of technique subcutaneous emphysema must be prevented. A small tracheal opening can be left to close spontaneously. A larger tracheal opening can be closed primarily with 4-0 Vicryl sutures. Strap muscles subcutaneous tissues and skin are closed loosely in layers with a drain beneath the strap muscles to prevent subcutaneous emphysema Figure 26 12 . Alternatively the incision may be left open and allowed to heal by secondary intention. This minimizes the risk of subcutaneous emphysema with an acceptable cosmetic result. Postoperative Care The patient is observed overnight in an intensive care unit or a similarly supervised setting for early detection and management of respiratory distress or subcutaneous emphysema. The drain is removed after 24 hours. Complications Subcutaneous emphysema Pneumothorax Respiratory distress 596 Surgical Atlas of Pediatric Otolaryngology BIBLIOGRAPHY Myers EN Stool SE Johnson JT. Tracheotomy. New York Churchill Livingstone 1985. Rothfield RE Petruzzeli GJ Stool SE. Neonatal tracheotomy tube modification. Otolaryngol Head Neck Surg 1990 103 133-134. Wetmore R. Tracheotomy. In Bluestone CD Stool SE Kenna MA editors. Pediatric otolaryngology. 3rd ed. Philadelphia PA WB Saunders 1996. .
