If tracheostomy must be re-instituted in a patient who had had one previously, it should generally be located precisely at the same location as the prior tracheostomy—unless there are pressing reasons not to do so. This is especially important if there is any stenosis at the prior site, and is an absolute requirement if there is significant stenosis at the site. This avoids injury to additional trachea and simplifies the operation (see Chapter 10, "Tracheostomy: Uses, Varieties, Complications").
In these patients, only a very short transverse incision is necessary; often about l cm in length. Since prior healing has scarred all tissue layers together at this point, the tiny incision is easily carried down into the tracheal lumen. If stenosis is present, dilation may be necessary, if not already performed bronchoscopically. For dilation, serially larger tracheostomy tubes (with obturators) or uterine dilators are useful.
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