The surgeon can minimize postoperative problems that may develop after tracheotomy by 1. ligating the veins that cross the midline (over-dependence on cautery often results in postoperative bleeding); 2. dividing and suture-ligating the thyroid isthmus; 3. avoiding sharp dissection or blind clamping at the sternal notch; 4. leaving the deep layers of the wound open, to avoid subcutaneous or mediastinal emphysema; 5. avoiding a low horizontal skin incision; and 6. using guide sutures at tracheal opening in the infant.
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John A. Kirchner (1986) studied this question.
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