PMC9871397_01
Neck wound after tracheostomy and temporary hemostasis using a mosquito pean. The posterior wall of the hypopharynx is recognized and the epiglottis can be observed. The top image shows the cephalic side, and the bottom image shows the caudal side.
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Although it was challenging to determine the normal anatomy due to massive bleeding and clots, we were able to achieve temporary hemostasis with mosquito forceps because the bleeding was not from the main trunk of the right common or internal carotid artery (Figure 1).
Using vascular tape, the right internal carotid artery, external carotid artery, common carotid artery, and right internal jugular artery were secured. The top of the image shows the cephalic side, and the bottom shows the caudal side.
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After removal of the intubation tube inserted from the wound (Figure 2), the right common carotid artery, right internal carotid artery, right external carotid artery, and right internal jugular vein were secured with vascular tape, being careful not to injure the right vagus nerve.
This illustration is presented for depicting the major blood vessels that were secured and those that had been dissected. The top of the image shows the cephalic side, and the bottom shows the caudal side.
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The bleeding vessels were then identified; the right lingual artery, right facial artery, and veins were considered the right common facial vein, right external jugular vein, and right superior thyroid vein, respectively (Figure 3).
The mucosa of the hypopharynx was ligated and sutured with 3-0 vicryl and the hypoglossal muscle group was sutured with 3-0 vicryl to repair the pharynx. The top of the image shows the cephalic side, and the bottom shows the caudal side.
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After hemostasis was achieved, the mucosa of the hypopharynx was ligated and sutured; the hypoglossal muscle group was also sutured to repair the pharynx (Figure 4).
Swallow angiography, performed on POD 15, shows no leakages.
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On POD 15, swallow angiography was performed, which revealed no leakages (Figure 5).