Tracheotomy is one of the oldest operative procedures. Asclepiades, in 124 bc, described a tracheotomy as a means of relieving upper respiratory obstruction. Since the time of Asclepiades, there has been a steady increase in the indications for tracheotomy. Today, many varied conditions from eclampsia1 to leprosy,2 are treated by this lifesaving operation. With the ever-growing use of the procedure, a more complete knowledge of the complications will help make it a safer, more effective tool in our hands.
The "snowplowing" of tissue from the tracheal wall by the tracheotomy tube which occurs during expiration (Fig 1), can cause difficulty in oxygen exchange severe enough to be incompatible with life. Snowplowing and tracheal irritation may also be the cause of other post-tracheotomy complications which, until now, have been poorly explained. The simple and successful correction of this difficulty should be known and understood by all who employ this