Aaron's Operative Note

The patient had an approximately 2 cm horizontal incision made through the subcutaneous tissues with a 15 blade approximately 1 finger breadth above the sternal notch. Using a Bovie pointed tip on coag and cutting, hemostasis was obtained and the dissection was carried down to the level of the visceral fascia. The strap muscles were separated using blunt dissection and the trachea was identified. We did not come upon the thyroid gland during the dissection or the innominate artery. After identifying the trachea, blunt dissection was used to palpate up the trachea to the level of the cricoid cartilage. After this was identified, two stay sutures were placed approximately at the level of the third tracheal ring, one was placed on the left and one was placed on the right, these were 4-0 silks, using the C.O. cutting needle. These were both secured on each side and at that point an approximately 0.5 cm vertical incision was made in the trachea using the 15 blade. During this time, traction was maintained on both stay sutures as well as on a tracheal hook that was placed at the superior aspect of the vertical incision in the trachea. The endotracheal tube was gradually backed out and during the period in which the patient's oxygen level was maintained in 99 percentile in terms of saturation, a 00 neonatal tracheostomy tube was placed. The ET tube was removed and the tracheostomy tube was repositioned and hooked up to the ventilator. Anesthesia and ventilation was continued to be provided by the Anesthesiology Team. The patient remained stable during this process. Next, two 4-0 prolene simple sutures were placed on each side of the horizontal superficial incision to narrow the incision some. There was one on the left and one on the right and the stay sutures were brought out medial to these. The stay sutures were then taped to the patients chest, one on the right and one on the left that were labeled both right and left accordingly. At that point, his small approximately 1 inch strip of Iodoform 1/4 inch gauze was then placed immediately inferior to the tracheostomy flange, inside the wound to serve as packing. This is to be removed in approximately 24 hours. Trach ties were then secured around the patient's neck with the patients cervical spine in a partially flexed position. The operation at that point being finished, the patient was then transferred to the Anesthesiology Team after it was clear that the tracheostomy tube had been tightly secured to his neck. Both stay sutures as previously mentioned were tapped to the patient's thorax, one on the right and one on the left and were labeled accordingly. The patient was then transferred to the Pediatric Intensive Care Unit with a postoperative chest x-ray ordered and care to be provided by the pediatric intensive care unit team.

Aaron Post-op

Aaron after tracheostomy surgery, Sept 22, 1993