Terminal or mural tracheostomy in the anterior mediastinum
Grillo, H.C.
Journal of Thoracic and Cardiovascular Surgery 51(3): 422-427
1966
ISSN/ISBN: 0022-5223 PMID: 5906360 Document Number: 3184
A new method is described for establishing a permanent terminal or mural tracheostomy in the anterior mediastinum at any point. A laterally blpedlcled flap of skin is dropped into a medlastlnal valley created by removal of the sternum, the clavicular heads, and the 1st and 2nd costal cartilages. The tracheostomy is established by accurate approximation of tracheal mucosa to the cutaneous margins of a circular hole in the center of the flap. The fairly extensive surgery which is necessary is justified by the following advantages prompt, dependable healing with primary epithelizatlon may be obtained; tension is minimized; complex suture lines subject to poor healing are avoided, as are long, open skin tubes which may cause crusting. The final result Is the simplest possible anatomic arrangement. Low anterior mediastlnal tracheostomy should be made only where primary reconstruction of the trachea may not or should not be accomplished. Techniques of wide resection and tracheal reconstruction were recently extended sufficiently, so that the indication for anterior medlastlnal tracheostomy Is largely narrowed to situations in which the larynx Is already sacrificed or must be sacrificed, and to situations In which local or distant pathology prohibits tracheal resectlon.
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