The tracheotomy punch for urgent tracheotomy.

INTRODUCTION Tracheotomy is a commonly performed surgical procedure for access to the airway. The overwhelming majority of tracheotomies are performed as elective procedures. In general, there are four categories of indications for tracheotomy: long-term mechanical ventilation, upper airway obstruction, need for pulmonary toilet, and as an adjunct to surgery where mechanical ventilation or obstruction is anticipated. A variable step in the operative tracheotomy is the method of creating an opening into the tracheal lumen. Several reports have assessed the use of single vertical or horizontal tracheal incisions and larger tracheal windows. Evidence suggests that the method of creating the tracheal window contributes to the degree of epithelialization, fibrosis, lymphocytic infiltration, and foreign body reaction at the stomal site, which may impact longterm complications. Regardless of the method of initial tracheal opening, eventually a circular tracheal defect may result due to circumferential pressure on the tracheal cartilage from the tracheotomy tube. In our institutions, the tracheotomy punch is included in all operative tracheotomy sets. It is used in all adult tracheotomies performed by the senior authors (D.G., D.W.E.). We describe five cases of urgent tracheotomy in which the tracheal punch was used to successfully create a uniformly sized tracheal window (Table I).