Tracheotomy

[[Image:Tracheotomy_neck_profile.png|thumb|166px|Completed tracheotomy:

How a tracheostomy is performed

• Curvilinear skin incision along relaxed skin tension lines (RSTL) between sternal notch and cricoid cartilage
• Midline vertical incision dividing strap muscles
• Division of thyroid isthmus between ligatures
• Elevation of cricoid with cricoid hook
• Placement of tracheal incision. An inferior based flap or Bjork flap (through second and third tracheal rings) is commonly used. The flap is then sutured to the inferior skin margin. Alternatives include a vertical tracheal incision (pediatric) or excision of an ellipse of anterior tracheal wall.
• Insert tracheostomy tube (with concomitant withdrawal of endotracheal tube), inflate cuff, secure with tape around neck or stay sutures.
• Connect ventilator tubing

You can also make a simple horizontal incision between tracheal rings (typically 2nd and 3rd) for the incision. Bjork flaps may produce more intratracheal granulation tissue at the site of the incisions, making it less favorable to some surgeons.

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