Paediatric tracheostomies are performed almost exclusively with an open surgical technique. Fig 1a shows stay sutures inserted either side of the window that has been cut into the exposed trachea. Fig 1b demonstrates what these sutures look like after the tube is inserted.

In order to encourage the stoma to become established maturation sutures are commonly used. These are shown in Fig 2 as the multiple, small sutures that circle the tracheotomy and secure the stoma to the surrounding neck tissues. Maturation sutures are not usually necessary during adult procedures.