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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.
TRACHEOSTOMY IS ONE of the most important techniques for patients who require long-term respiratory support such as mechanical ventilation.1· 2 We often adopt this procedure during the process of weaning patients from mechanical ventilation, because tracheostomy can facilitate this process.3· 4 Recently, percutaneous tracheostomy has become more familiar to intensi vists, and today, there exist commercial kits that make tracheostomy a safe and easy technique for patients with normal necks. 5^7 However, in patients with severe cervical inflammation or infection, contaminated injury, or a contaminated or open surgical wound requiring open drainage in the anterior neck close to the site of the tracheostomy, we hesitate to perform tracheostomy because of the risk for contamination of the tracheostomy site from the dirty wound and contamination of the wound from sputa and saliva from the tracheostomy.8-10 In our institute, we have tried to perform tracheostomy by the paramedian approach to prevent this risk."-13 The aim of this study is to present and clarify the usefulness and safety of open tracheostomy by the paramedian approach as a treatment for cervical infection.
Techniques
The indications...