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Here, however, the circumferentially damaged segment of the trachea is also excised (Figure 27-4B). Healthy tissue is placed over the sutured arterial stumps and the tracheal suture line. If the patient is still on a ventilator, as is likely, the tube cuff for continued ventilation should be positioned either well above or, more likely, well below the anastomotic line, in order to avoid either pressure or inflammation at the level of the tracheal anastomosis. Muscle is pedicled over the tracheal anastomosis to seal it from the tra-cheostomy. If necessary, the stoma may be sealed with a pedicled strap muscle, and an endotracheal tube employed with proper positioning of the cuff remote from the anastomosis. Tube position is checked bron-choscopically.

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