Tracheostom
y
i
s
hardl
y
performe
d
i
n
patient
s
wit
h
cervica
l
infectio
n
clos
e
t
o
th
e
sit
e
o
f
tb
e
tra
-
cheostomy
.
Thi
s
stud
y
aime
d
t
o
presen
t
an
d
clarif
y
th
e
usefulnes
s
an
d
safet
y
o
f
ope
n
tracbeos
-
tom
y
performe
d
b
y
th
e
paramedia
n
approac
h
technique
.
Tb
e
procedur
e
i
s
a
s
follows
.
A
2.5-c
m
paramedia
n
incisio
n
i
s
mad
e
fo
r
th
e
tracheostom
y
o
n
tb
e
opposit
e
sid
e
o
f
infectiou
s
focus
;
th
e
anterio
r
nec
k
muscle
s
ar
e
dissecte
d
an
d
split
;
tb
e
trache
a
i
s
fenestrate
d
b
y
a
revers
e
U-shape
d
incision
;
an
d
th
e
fenestra
l
fla
p
o
f
th
e
trache
a
i
s
fixe
d
t
o
th
e
skin
.
W
e
use
d
thi
s
techniqu
e
i
n
fiv
e
patients
.
Ther
e
wer
e
n
o
complication
s
suc
h
a
s
bleeding
,
desaturation
,
an
d
displacemen
t
o
f
th
e
tube
;
an
d
ther
e
wer
e
n
o
postoperativ
e
complication
s
suc
h
a
s
sever
e
contaminatio
n
o
r
infectio
n
o
f
th
e
tracheostom
y
sit
e
fro
m
th
e
nearb
y
cervica
l
wound
,
difficult
y
i
n
securin
g
th
e
tracheostom
y
tub
e
an
d
connectin
g
devic
e
t
o
th
e
ventilator
,
difficultie
s
i
n
dail
y
managemen
t
an
d
care
,
o
r
dis
-
locatio
n
o
f
th
e
tracheostom
y
tube
.
Al
l
wound
s
resultin
g
fro
m
th
e
tracheostom
y
wer
e
kep
t
separat
e
fro
m
an
d
no
t
contaminate
d
b
y
th
e
nearb
y
dirt
y
wounds
.
Ope
n
tracheostom
y
b
y
th
e
paramedia
n
approac
h
techniqu
e
i
s
usefu
l
an
d
saf
e
fo
r
patient
s
wit
h
sever
e
cervica
l
infectio
n
requirin
g
ope
n
drainag
e
an
d
lon
g
ventilator
y
management