title: Usefulness and safety of open tracheostomy by a paramedian approach for cervical infection: esophageal and tracheal injury and necrotizing fascitis.
abstract: Tracheostomy is hardly performed in patients with cervical infection close to the site of the tracheostomy. This study aimed to present and clarify the usefulness and safety of open tracheostomy performed by the paramedian approach technique. The procedure is as follows. A 2.5-cm paramedian incision is made for the tracheostomy on the opposite side of infectious focus; the anterior neck muscles are dissected and split; the trachea is fenestrated by a reverse U-shaped incision; and the fenestral flap of the trachea is fixed to the skin. We used this technique in five patients. There were no complications such as bleeding, desaturation, and displacement of the tube; and there were no postoperative complications such as severe contamination or infection of the tracheostomy site from the nearby cervical wound, difficulty in securing the tracheostomy tube and connecting device to the ventilator, difficulties in daily management and care, or dislocation of the tracheostomy tube. All wounds resulting from the tracheostomy were kept separate from and not contaminated by the nearby dirty wounds. Open tracheostomy by the paramedian approach technique is useful and safe for patients with severe cervical infection requiring open drainage and long ventilatory management.
authors.affiliation: Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan. qqc3@urahp.yokohama-cu.ac.jp
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Moriwaki
authors.forename: Mitsugi
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Masayuki
authors.initials: M
authors.lastname: Iwashita
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Harunari
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Toyoda
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kosuge
authors.forename: Shinju
authors.initials: S
authors.lastname: Arata
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Suzuki
mesh_terms: D004322:Drainage / Q000379:methods; D004935:Esophageal Diseases / Q000601:surgery*; D004947:Esophagus / Q000293:injuries*; D019115:Fasciitis, Necrotizing / Q000601:surgery*; D006801:Humans; D009334:Neck Muscles / Q000601:surgery; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000601:surgery*; D014132:Trachea / Q000293:injuries*; D014139:Tracheostomy / Q000379:methods*