At a certain point, Sarah makes a perforation on the front of her neck with a sharp stick nearby. This is known as a tracheotomy and it's done to relieve an obstruction of breathing. A hole is created through the front of the neck and into the windpipe (trachea).
In Spain didn't have a theatrical release until 2016, 9 years later. The film was only released in Barcelona (Phenomena) for 2 days in subtitled version and 35 mm. copy. In 2012, also was a premiere in Madrid (Artistic Metropol) for 3 days in subtitled version.