Small Animal Referral Hospital Permanent Tracheostomy

A permanent tracheostomy surgery involves making a permanent opening into the trachea at the level of the neck. The aim is to bypass airway obstruction found higher up at the level of the larynx, soft palate and within the head.

We consider this a ‘salvage’ procedure to be reserved for when all other options have been explored.

• When successful, patients can shift air via the tracheostomy site very well, therefore it can significantly improve quality of life.
• Patients can better cope with the airflow demands required for exercise and activity.
• Safer for future anaesthetic/recovery.
• Reflux and regurgitation risks are less significant.

However, this procedure does not come without complications and ongoing care, which we will discuss below.

• The sound of your dog’s bark may change.
• Your pet will no longer be able to wear a neck collar or lead and will require a harness for all walks – Buddy Belts or Perfect Fit harnesses work well to avoid the stoma site.
• Your pet will be at an increased risk of inhalation of foreign material, food, and water into the stoma site. Supervision around water bowls and lifetime care around outside areas will be required to avoid aspiration or drowning. In particular areas with any access to water or foreign materials – e.g. beach sand/water, long grass.
• Covering the stoma can help to protect from dry foreign materials – breathable tracheostomy covers can be purchased, or some owners choose to use a bandana.

Talk to us about where you can purchase your tracheostomy covers.

The new opening into the airway is called a stoma. Initially there will be a lot of mucus production as the body adjusts to the new stoma. Following surgery, this may need cleaning up to every few hours. This process may need to be continued lifelong; however, the frequency often reduces to only a few times daily long term.

• Clean any exudate or mucus from around the outside of the stoma and surrounding skin with boiled and cooled salted water/saline using gauze swabs or cotton buds. Avoid using cotton wool due to the risk of inhaling small fibres. WaterWipes can be helpful and can be purchased from the supermarket.
• DO NOT wipe inside the stoma as the tracheal mucosa is very sensitive.
• To help stop the skin around the stoma becoming irritated by any discharge or mucus, Vaseline can be applied to act as a barrier film.
• Coupage and nebulisation following surgery can help to help to loosen up any excess mucus. This can be performed at home. You can put your pet into the bathroom and run a hot shower or nebulisers can be purchased online.
• The stitches will need to be removed approximately two weeks following surgery once the stoma site has healed. This can be performed at your local vets. Your pet may need a light sedation for this depending on their temperament.

It may take some time for your pet to learn how to breathe through the tracheostomy stoma, especially whilst lying down or sleeping. Whilst your pet is adjusting to the change in breathing location, a rolled-up towel or pillow can be used to position their head in an extended position to aid sleep and help them to breathe more comfortably.

There are a number of possible complications related to this surgery, some of them are life limiting.

• There is potential for the stoma site to heal over with scar tissue formation. Repeat surgery may be required to revise the stoma. This is not always successful.
• There may be some bleeding at the time of surgery, however this is not usually serious.
• To create the tracheostomy, it is necessary to remove part of the cartilage rings of the trachea. This can lead to weakening of the trachea, causing the trachea to collapse when breathing. This has a poor prognosis as it is difficult to resolve and may result in euthanasia.
• Wound breakdown is not uncommon, if this occurs this is normally managed without additional suturing.
• When performing a permanent tracheostomy, some of the excess skin folds found in the neck region may need to be removed. This is to ensure that the stoma is not obstructed. This may be a staged process, with a revision surgery performed later once swelling from the initial surgery has reduced. This will ensure that there is not excessive tension on the skin which can impact healing.
• Weight loss prior to surgery is vital to reduce soft tissue volume within the neck. Excessive weight in this area is a potential obstruction risk. Please ask us, or your local vet for help with this if needed.