Tracheostomy Placement
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.12,13