Fantoni's translaryngeal tracheotomy complications. Personal experience.

Tracheotomy is a surgical procedure which, in conditions of acute respiratory emergency, guarantees an adequate airway through the trachea whereas, in cases of chronic respiratory failure, it is used to improve ventilation through the reduction of the dead respiratory space. Over the last few years, surgical techniques used in tracheotomy have been considerably modified, not only to respond to the needs of clinical indications but also on account of problems related to management of the patient and tracheostomy tube, particularly in the home setting. Besides traditional surgical techniques, in fact, in the Intensive Care Unit, percutaneous dilatative procedures are being used with increasing frequency, in particular, translaryngeal tracheotomy according to Fantoni. The latter, however, according to reports in the literature, has been shown to be followed by a higher peri-operative complication rate (40%) which involves maintenance of good function of the tracheostomy, a condition which is particularly dangerous in the management of patients in the home setting. Personal experience is described in the management of 6 patients submitted to tracheotomy according to Fantoni and in combined home treatment, who, some time after the operation. presented 'embedding' of the tracheostomy tube in the tracheostomy opening. The six patients were treated at home with ventilatory support using automatic ventilation system and were submitted, in our Clinic, to a surgical review with preparation of a tracheotomy according to the conventional method. Our experience showed a particular feature of the difficulty in the management of patients presenting respiratory diseases, submitted to translaryngeal tracheotomy and, thereafter, maintained in combined home treatment: in these subjects, in fact, the presence of the tube, the difficulty in cleaning the peristomial skin, the reduced autonomy from the automatic ventilation system and the frequent coexistence of mucopurulent tracheo-bronchial inflammatory diseases, trigger micro-lesions of the stoma and, therefore, scar keloid, narrowing of the lumen and embedding of the tube itself. In conclusion, in our personal experience, we are of the opinion that translaryngeal tracheotomy, since it is easily carried out and is a slightly invasive procedure, plays a very important role in the management of the Intensive Care Unit patient but should be reserved for the few cases requiring tracheostomy for limited periods of time, in low risk patients and within the first 18 days after the acute damaging event.

La traqueotomía diez años después / Percutaneous trachestostomy tne years later

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Anatomía del cerdo aplicada a la experimentación en cirugía general / Anatomy of the pig applied to experimental general surgery

Basándonos en la experiencia personal de cirugía experimental durante 10 años en 170 cerdos de raza Large-White, realizamos una extensa exposición de los conocimientos anatómicos adquiridos con especial referencia a su aplicación en cirugía experimental, con detalles prácticos de manejo anesté sico y quirúrgico de algunos procedimientos técnicos. La información está referida siempre a cerdos jóvenes (de 20 a 40 kg de peso). En el artículo se pueden distinguir las siguientes partes: a) anatomía del cuello, con especiales referencias a la intubación orotraqueal, a la realización de traqueotomía para ventilación, y a accesos venosos centrales y arteriales en el cuello y en otras regiones anatómicas del animal; b) anatomía de las vísceras y estructuras vasculares del tórax: el corazón con los troncos supraaórticos y sus ramas, la anatomía del retoro venoso, del árbol traqueobronquial, de los pulmones y del mediastino; c) anatomía vascular del abdomen: sistema arterial del abdomen (con todas sus ramas viscerales), sistema venoso portal y sistema venoso de la cava inferior; d) anatomía del aparato digestivo, que es la parte más extensa, y se compara específicamente frente a la anatomía humana: intestino delgado y grueso: el colon con grandes diferencias morfológicas; estómago y bazo: con algunas diferencias de vascularización; hígado: importantes diferencias en segmentación, fijación al retroperitoneo, anatomía del hilo hepático y epiplón gastrocólico, ramificación portal y de las venas suprahepáticas, y páncreas y duodeno: vascularización y drenaje venoso, situación parcialmente intraperitoneal, y e) anatomía del sistema genitourinario: genitales internos de la hembra, riñones, uréteres, vejiga y uretra.Para mejorar las descripciones anatómicas, los aspectos de mayor interés se ilustran con dibujos (AU)