16 Four Sutures in the Carotid Sheath

I find it helpful to place four sutures of 4-0 silk or Neurolon in the carotid sheath, to hold open the tissue planes and elevate the carotid from its vascular bed. It is impossible to use a retractor to do this as effectively as these simple sutures. In this illustration one can see how nicely this isolates the surgical planes and defines the workspace for carotid reconstruction.