%20(1)%20(1).gif)
- INCISION: Transverse skin crease incision is made 2-3 cm above the sternum. (Lower than this causes Scar hypertrophy)
- Subplatysmal flap: platysma incised in line with Skin, Skin Platysmal flap raised. Inferior limit - sternum, superiorly up to Thyroid cartilage.
- Joll's self retaining retractor to retract flaps.
- Deep cervical fascia incised vertically in midline.
- Strap muscle retracted laterally.
- Horizontal division of strap muscles is NOT necessory. But if done, it should be Highup (because innervations are below)
- Areolar tissue around gland is divided.
- Middle, Inferior thyroid veins displayed, ligated, divided.
- Right angled forceps behind superior pole vessels.
- Superior pole vessels ligated as Low as possible & a second ligature is tied above it. Vessels divided b/w ligature [Too high a tie can endanger ELN]
- Thyroid lobe retracted medially and carotid sheath Laterally this displays inferior Thyroid artery & RLN beneath fascial layer. which is then incised.
- Inferior thyroid artery ligated as lateral as possible.
- Dissection of deep portion of gland off RLN and parathyroid done
- Medial surface of the lobe is seperated from trachea.
- Isthmus is divided close to contralateral lobe.
- For Hemostasis, continuous absrobable suturing in isthumus is done (OR) Harmonic Scalpel is used to divide isthumus.
- Vaccum Drains is placed beneath strap muscle
- Platysma is sutured & skin closed using suture/staples.
