What's the name of this incision?
This incision is made one inch above the sternal ends of the clavicles starting from lateral margin of one sternomastoid to the lateral margin of the other sternomastoid. In the operation of excision of a nodule or of hemithyroidectomy, however, the incision need not be so long but at the same time it Must be adequate enough to allow palpation of the rest of the thyroid to exclude presence of other nodules (Fig. 86.2). • The skin, subcutaneous tissue and platysma are cut. It is better that the platysma is cut at a different level from the skin as this can minimize the scar. • The skin flaps are mobilized up and down to upper border of thyroid cartilage and to the suprasternal notch respectively. • The investing layer of the deep cervical fascia is incised vertically in the midline. The infrahyoid muscles are retracted. The anterior surface of the gland covered with pretracheal fascia is exposed.This fascia is incised and a finger is insinuated to know the whole extent of the goiter. In case of big thyroid swelling, the strap muscles have to be cut, to get proper exposure. The muscles, if cut, should be incised as high as possible because, the nerves are coming from below upwards • The superior pole of the gland is first delivered at the wound, where the superior thyroid vessels are clamped as close to the gland as possible to prevent injury to the external laryngeal nerve and then divided. The middle thyroid vein is hgated and cut at posterolateral border of thyroid. The inferior thyroid artery is hgated away from the lower pole to prevent injury to the recurrent laryngeal nerve. Inferior thyroid veins are ligated and cut at the lower pole Same steps are repeated on the other side. After the vessels have been ligated, resection of the thyroid is done as is required, Le. partial, subtotal or total. The cut sruTace of the remaining thyroid tissue, which often bleeds considerably, even after long vessels have been ligated, is sutured with mattress stitches to achieve hemostasis, which must be perfect. A corrugated rubber drain is put on each side of the trachea and the wound is closed in layers. • The platysma is stitched after the sandbag is removed. • The skin is closed with interrupted stitches or with a subcuticular suture.
