Tracheostomy tube insertion in the pretracheal fascia

A case of massive dissecting emphysema secondary to attempted emergency tracheostomy is reported. Malpositioning of the tube in the pretracheal fascia and positive pressure ventilation were the cause of the dissecting emphysema. This problem was recognized with subsequent removal of the tracheostomy tube, but unfortunately the skin was sutured which prevented air from escaping. The diagnosis was made by physical examination and chest roentgenogram. It was successfully treated by reopening of the wound and evacuation of clots. Careful technique performed under optimal conditions is of paramount importance in avoiding this complication.