Instead of the classical horizontal tracheostomy skin incision, the "Batman" incision is designed in such a way as to have a superiorly based skin flap and a corresponding square defect in the inferior margin.
The platysma and deep cervical fascia are divided and the stap muscles are retracted laterally to uncover the anterior tracheal wall. An inferiorly based trapdoor flap is marked on the anterior tracheal wall with the electric knife.
The trapdoor flap is everted and sutured to the square defect in the inferior margin of the incision. The skin flap is inverted and sutured to the upper edge of the anterior tracheal wall opening.
Finally, the lateral edges ("wings") of the incision are sutured together, forming a straight line. Finally, the tracheotomy tube is inserted into the trachea and secured with sutures and umbilical tape.
The advantages of this technique are the prevention of an accidental introduction of the tracheostomy tube into a false passage in the mediastinum. If the tracheostomy tube is dislodged, it can be easily replaced. Post-operative bleeding is minimal or inexistant.