PubMed · 10512302
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J L Nates, M Joseph. 1999. Percutaneous tracheostomy techniques.. https://doi.org/10.1097/00000539-199910000-00060
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In a safety evaluation study, relative force and distance measurements during percutaneous tracheostomy were recorded using specially monitored Griggs guidewire dilating tracheostomy forceps on 12 cadavers scheduled to undergo postmortem examination the same day. All measurements were recorded in millivolts and were converted to force and distance via appropriate calibration tables. Markedly more force was required for tracheal destruction than for therapeutic tracheal dilation (87.7 N +/- 19 N vs. 31.6 N +/- 17.1 N, p <0.001). Also relatively less force was required for therapeutic tracheal dilation than for dilation of the pretracheal tissues (44.4 N +/- 17.1 N vs. 31.6 N +/- 17.1 N, p <0.05). These results suggest that the Griggs tracheostomy forceps have a reasonable margin of safety in that tracheal destruction is unlikely to occur inadvertently during therapeutic dilation. Second, the dilation of pretracheal tissues can act as useful guide in knowing how much force to apply in a therapeutic dilation.
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OBJECTIVE: To determine if patients who undergo tubularized incised-plate (TIP) urethroplasty need regular dilatation to prevent neourethral strictures or meatal stenosis. PATIENTS AND METHODS: The follow-up of two consecutive series of patients who underwent primary TIP hypospadias repair by one surgeon was reviewed. The first 72 patients (group 1) had periodic neourethral calibrations for 1 year after repair, while the next 62 patients (group 2) had no routine dilatation, except for six patients (10%) in whom the meatus appeared to be small. Urethroscopy was performed in both groups at the time of fistula repair, skin revisions or during anaesthesia for unrelated procedures. RESULTS: There was no evidence of scarring in group 1; one case of meatal stenosis and one neourethral stricture were detected in group 2. The difference in outcome was not statistically significant (P = 0.4). Overall, the incidence of meatal stenosis was low (0.7%) and comparable with most recent series in which postoperative calibration was not used routinely. CONCLUSION: Dilatation of the neourethra is unnecessary after TIP urethroplasty. Calibration or uroflowmetry 6 months after surgery may be useful to detect subclinical obstruction.