We have been involved in the emergency management of life-threatening thyroid haematomas and followed the multidisciplinary consensus guidelines published in Anaesthesia, resulting in safe management of these patients [1]. We had expected to expose the Skin; Cut sutures; Open skin; Open muscles; and Pack the wound (SCOOP). However, on more than one occasion, surgical closure of the neck wound with skin glue did not match what we expected to find. As a result, the skin needed to be opened (step 3) before the subcuticular sutures could be cut (step 2). This introduced an element of confusion and self-doubt into a stressful scenario and potentially delayed definitive intervention. There may be circumstances where an anaesthetist needs to immediately reopen the neck wound, where knowledge of the neck anatomy is paramount.

Here, we describe the key steps in wound closure following thyroid surgery and compare skin closure with staples (Fig. 1) to glue (Fig. 2). The trachea lies deep to the strap muscles (Fig. 1a) and therefore these muscles must be opened to relieve the pressure caused by post-thyroidectomy haematoma. This is the cavity in which a drain is usually placed. When closing the layers from deep to superficial, the strap muscles (which directly overlie the thyroid gland and empty thyroid cavity) are usually sutured together in a vertical fashion (Fig. 1b).

Platysma is the next layer and is always closed (Fig. 1c). Some surgeons perform a subcuticular stitch, which lies underneath the skin, before stapling the skin (Fig. 1d). This is an old-fashioned technique and staples are rarely used these days. Most surgeons now do a subcuticular stitch and then apply glue to achieve a neat scar (Fig. 2). As the subcuticular sutures are underneath the skin, they will not be visible to cut through. Occasionally, the surgeon will do a subcuticular stitch and then put wound closure strips on the skin surface.

Importantly, when glue is used, the first step is to immediately dissect to open the wound (local anaesthetic is not required) before cutting the subcuticular sutures. This is an area of potential confusion in high-acuity scenarios. Furthermore, it may be worth updating the guidelines to indicate that the platysma (that is sutured in a horizontal fashion) and strap muscles (that are sutured in a vertical fashion) may also need to be opened in order to completely relieve the pressure caused by a post-thyroidectomy haematoma.

我们参与了危及生命的甲状腺血肿的紧急管理，并遵循《麻醉》杂志上发表的多学科共识指南，从而对这些患者进行了安全管理[ 1 ]。我们原以为会暴露皮肤；但结果却是这样。剪断缝线；打开皮肤；打开肌肉；包扎伤口 (SCOOP)。然而，不止一次，用皮肤胶对颈部伤口进行手术闭合的情况与我们预期的情况不符。因此，在切割皮下缝合线（步骤 2）之前，需要打开皮肤（步骤 3）。这给紧张的情况带来了困惑和自我怀疑的因素，并可能延迟最终的干预。在某些情况下，麻醉师可能需要立即重新打开颈部伤口，此时了解颈部解剖结构至关重要。

在这里，我们描述了甲状腺手术后伤口闭合的关键步骤，并比较了用U形钉（图1）和胶水（图2）进行皮肤闭合。气管位于带状肌肉深处（图1a），因此必须打开这些肌肉以缓解甲状腺切除术后血肿造成的压力。这是通常放置排水管的腔体。当从深层到浅层闭合各层时，带状肌肉（直接覆盖甲状腺和空甲状腺腔）通常以垂直方式缝合在一起（图1b）。

颈阔肌是下一层并且始终是闭合的（图 1c）。一些外科医生在缝合皮肤之前会在皮肤下方进行皮下缝合（图 1d）。这是一种老式技术，现在很少使用订书钉。现在大多数外科医生都会先进行皮下缝合，然后涂上胶水以形成整齐的疤痕（图 2）。由于皮下缝合线位于皮肤下方，因此无法看到它们被切穿。有时，外科医生会进行皮下缝合，然后将伤口闭合条放在皮肤表面上。

重要的是，使用胶水时，第一步是立即解剖打开伤口（不需要局部麻醉），然后再切割皮下缝合线。这是高敏锐度场景中潜在混乱的领域。此外，可能值得更新指南以表明颈阔肌（以水平方式缝合）和带状肌（以垂直方式缝合）也可能需要打开，以完全缓解由甲状腺切除术后血肿。