MR. GUNN: could you describe about how big the tracheostomy wound was that you cut?
DR. PERRY: I've been asked this a lot. Of course, some of them said it was too big for a surgeon but my reply to that was that it was big enough.
There are only two medical emergencies, airway & bleeding. Everything else can wait. This just couldn't wait, and I had no idea how big it was. I made it big enough. At that time we used old metal flange tracheotomy tubes and quite large [sic] with a cuff on them. And when I made the incision through the wound , I made it big enough that I could look to either side of the trachea. There was blood in the trachea through the end - when I looked through the pharyngoscope and attempted to put in the tracheal tube with blood inside the trachea.
There was hair [sic = "air"] in the mediastinum, and I didn't know whether I was going to encounter carotid arteries or whatever. But the path of the bullet clearly put those vessels at risk as well as the trachea, so I made the wound big enough to do that.
How big it was, I don't know. I'm sure Dr. Humes measured it to see when they got there. When he found out it was a tracheostomy, he measured. But since I made the transverse incision, went right through it, I made it big enough to control an underlying bleeding blood vessel if necessary and big enough to do a trach.
How big it was, who knows. Ron might know, but I don't know. Big enough.
DR. JONES: I was busy putting in the left chest tube and doing a cut down on the left arm and I was not paying a lot of attention to that.
DR. PERRY: We were all -
DR. JONES: I thought it was about an average size incision. I didn't see anything abnormally large or abnormal length of the incision.
DR. PERRY: It was bigger than I would make for an elective situation. In a patient that's not in extremis where you're doing an elective tracheostomy you make a nice tiny skin line incision in order to minimize the subsequent scarring. In an emergency situation, you make an incision adequate to accomplish the job, and in this case it was going to take more. After I'd made the incision, Dr. McClelland arrived and his hands came in to help me with the tracheostomy, but I'd made the incision at that time but Bob may recall how big it was because he held the retractors for it. It was big enough for me to control the trachea, and if necessary, to do a little more. [Bolding mine]
