Soft Tissue Surgery: Surgery of the Respiratory Tract Flashcards
Label the missing layers of the trachea
1. What is the blood supply of the trachea?
2. What innervates the trachea?
- Segmental blood supply- thyroid and bronchoeosophageal artery
- Right vagus nerve
What different investigations can be done on the trachea?
- Clinical examinations
- Radiography
- Computed tomography
- Fluoroscopy
- Trancheobronchoscopy
- BAL
What is the surgical approach to the cervical trachea?
- Dorsal recumbency and straight and neck extended over a sand bag
- Ventral midline longitudinal incision from caudal to larynx
- Seperate the sternohyoideus muscles- stay on midline
What is the surgical approach to the thoracic trachea?
- First part: cervical approach and cranial retraction and cranial median sternotomy
- Median sternotomy or right 3rd-5th thoracotomy
- Refer
How is trachea closed?
- Absorbable monofilament
- Simple interupted
- Knots placed extraluminally
- Careful apposition of mucosa
When is a temporary tracheostomy indicated?
- Life threatening upper airway obstruction- BOAS, laryngeal paralysis, laryngeal foreign bodies, neoplasia
- GA when intra-oral surgery is performed
What equipment is needed for a temporary tracheostomy?
- Surgical instruments
- Tracheostomy tubes- uncuffed/cuffed
- Large suture material
- Umbilical tape
What managment is needed for a temporary tracheostomy?
- ICU- 24hr monitoring- block or dislodge
- Replace tube 2x daily
- Suction
- 0.2ml/kg sterile saline down or nebulise
What complications can occur with a temporary tracheostomy?
How should it be removed?
- Plugging of tube
- Tube removal
- Gagging, coughing
- Subcutaneous empysema, pneumomediastinum, pneumothorax
- Infection
- Stenosis
- Occlude tube before removal
- Second intention healing
When is a permanent tracheostomy indicated?
Salvage procedure- unresolvable URT obstruction
What are the indications, complications for tracheal resection?
What is the max number of rings removed?
Indications
* Trauma
* Stenosis
* Neoplasia
* Avulsion
Complications
* Air leakage
* Infection
* Stricture
No more then 6 rings
- What causes tracheal rupture, how is it treated?
- How is avulsion treated?
- Overinflation of ET tube (cats), medical managment?
- 1-4cm cranial to bifurcation, resection and anastomosis
- What causes tracheal collapse?
- What breeds are predisposed?
- What are the clinical signs?
- Laxity of trachealis muscle > weakness of rings
- Middle-aged small/toy breeds
- Goose-honk cough, dyspnoea, excercise intolerance, cyanosis
What are the different grades of tracheal collapse?
- I laxity of dorsal tracheal membrane 25% luminal collapse
- II- loss of cartilage rigidity and further laxity, 50% luminal collapse
- III- flattening of the cartilages- 75% collapse
- IV- 100% loss of integrity
- How is tracheal collapse medically managed?
- How is it treated in an emergency?
- Corticosteroids (anti-inflam), anti-tussives, bronchodilators, ABs, weight loss, harness
- Oxygen, sedatives, steroids
What are the complications of extraluminal prosthetic tracheal rings?
- Necrosis
- Collapse beyond rings
- Migration of prosthesis
- Tension pneumothorax
What are the complications of intralumnal tracheal stenting?
- Stent fracture
- Stent migration
- Inflammatory tissue
What are the different surgical approaches to the thorax?
- Intercostal thoracotomy
- Median sternotomy
- Transsternal thoracotomy
- Rib resection thoracotomy
- Transdiaphragmatic thoracotomy
- Thoracoscopy
What does an intercostal thoracotomy allow access too an not?
What special retractors are needed?
Access to R or L thorac
Cannot access structures away from the incision
Finochietto retractors
- What is a median sternotomy used for?
- What ideally needs to be preserved?
- How is it closed?
- Bilateral exploration of the thoracic cavity
- Preserve the manubrium or xyphoid
- Peristernal orthopaedic wire in figure of 8
Large non-absorbable suture material
Crimped leaderline
What are the indications for a lung lobectomy?
- Lung lobe torsion
- Localised pulmonary abscess, cyst, bulla, neoplasia
- Severe lung trauma
- Broncho-oesophageal fistula
- What are the two techniques for a total lung lobectomy and partial?
Suture ligation or stapling technique
How can lung lacerations be managed?
- Conservative managment for at least 3 days
- May require median sternotomy and suturing
With thoracic trauma (RTA, bite wound etc), what is the priority?
How is this initially done?
- Restore cardiopulmonary function
- Maintain a patent airway- provide O2
- Support circulation- IV access- fluids
- Control obvious haemorrhage
What are common injuries from thoracic trauma?
- Pulmonary contusions
- Pneumothorax
- Rib fractures
- Open thoracic wounds
- Haemothorax
- Diaphragmatic rupture
- Shock
What should be examined about a patient with thoracic trauma?
- Respiration rate and pattern
- Mucus membrane colour
- CRT
- Auscultation and percussion of thorax
- Observation of thoracic outline
- Check for evidence of wounds
- Minimise patient stress
What diagnostic tests could be considered for thoracic trauma?
- Haematology
- Serum biochemistry
- Radiography
- Thoracocentesis
What needs to be considered for complications and treatment of rib fractures?
- Often incidental findings
- Suspect pulmonary contusion (hematoma)
- Conservative managment usually adequate
- Analgesia, rest, O2 supplementation
- Internal rib fix may be required
- Can cause lung lacerations
- What is flail chest?
- Why does this compromise respiration?
- What may be required?
- segment of one or more ribs is fractured in two planes
- This segment can move independently from the chest wall- paradoxical movement compromises resp
- Possibly surgical stabilisation
How is a diaphragmatic rupture managed?
- Surgery when the patient is stable
- Surgery straight away is the stomach is herniated- needle compression
- If chronic consider no treatment
Midline coeliotomy- hernia reduction gently
Diaphragmatic closure: PDS in a simple continuous ± interrupted pattern
