John has now been off of the ventilator for 28 hours straight. If he continues to do well, they will not put him back on the vent at all. He is hooked up to a hose with incoming moist oxygen. Continuing steps involve decreasing the size of his trachea, increasing the time that he uses his speaking valve, and decreasing his secretions. The wound healing is going  slowly. The doctor will let us know when  he thinks some sort of “flap” surgery is indicated.  Skin grafts are not a viable option because of the continued pressure that will always exist in the damaged areas.