A tracheostomy tube may be placed surgically or
percutaneously. Surgical placement is done in the operating
room or at the bedside, generally with use of general
anesthesia. A stoma is created by using an open
surgical technique. Landmarks are identified, and a skin
incision is made below the cricoid cartilage. The isthmus
of the thyroid gland is exposed, cross-clamped, and ligated.
The
trachea can
then be
visualized.
A common
technique is
to create a “trap door” (Björk flap) in which a small part
of the tracheal cartilage is pulled down and sutured to
the skin. This flap is thought to facilitate reinsertion of
the tracheostomy tube if accidental decannulation occurs,
especially in patients with difficult anatomy or obesity