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Surgical correction of a percutaneous dilatational tracheostomy: A case report.
Aldemyati, Razaz; Paparoupa, Maria; Kluge, Stefan; Grotelüschen, Rainer; Burdelski, Christoph.
  • Aldemyati R; Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Paparoupa M; Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: m.paparoupa@uke.de.
  • Kluge S; Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Grotelüschen R; Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Burdelski C; Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Int J Surg Case Rep ; 95: 107248, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1867261
ABSTRACT
INTRODUCTION AND IMPORTANCE Percutaneous dilatational tracheostomy (PDT) has become a routine procedure in intensive care, because of its multiple advantages over surgical tracheostomy (ST). CASE PRESENTATION We present the case of a 72-year-old patient with SARS-CoV-2 pneumonia, who received a PDT in the 6th tracheal ring with a lateral puncture of the trachea. This atypical placement of tracheostomy was due to a massive left-pronounced goiter, causing a tracheal shift to the right. To avoid dislocation of the tracheal cannula and prevent recurrent bleeding, surgical revision was decided. After left hemithyroidectomy, oral intubation was temporarily necessary, in order to remove the old tracheostomy. Then suturing of the left lateral tracheal defect and standard ST in the 2nd tracheal cartilage was performed. The patient was successfully weaned and decannulated and his swallowing function remained intact. CLINICAL

DISCUSSION:

In our case left hemithyroidectomy was necessary, in order to enable an optimal surgical tracheostomy in the 2nd tracheal cartilage. Because mechanical ventilation was carried out proximal to the large tracheal defect after PCT, a secondary closing approach was not an option. The endotracheal cuff was placed above the defect, in order to prevent acute or chronic intraluminal pressure trauma. Postoperative x-ray and bronchoscopy insured the sufficient sealing of the tracheal suturing.

CONCLUSION:

We describe an unusual placement of percutaneous dilatational tracheostomy through a thyroid goiter and our approach to perform a correction surgical tracheostomy.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Prognostic study Language: English Journal: Int J Surg Case Rep Year: 2022 Document Type: Article Affiliation country: J.ijscr.2022.107248

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Prognostic study Language: English Journal: Int J Surg Case Rep Year: 2022 Document Type: Article Affiliation country: J.ijscr.2022.107248