sx approach to the thorax Flashcards
explain the sx area for removing Esophageal foreign body at heart base using thoracotomy
right lateral thoracotomy at 4th intercostal space
surgical approach to Cardiopulmonary bypass
right lateral thoracotomy at 4th intercostal space
sx site for Cranial lung lobectomy
both left and right lateral thoracotomy
5th interspace
surgical approach to Intermediate lung lobectomy
6th interspace on the right
sx approach of Caudal lung lobectomy
both left and right lateral thoracotomy at 7th interspace
sx site for Thoracic duct (dog)
8thintercostal
on right side in dog
left side in cats
sx site for cranial thoracic duct
left thoracic intercostal at 3rd intercostal
surgical site for PDA, PS, PRAA, pericardium
left thoracotomy at 4th interspace
sx site for Cranial lung lobectomy
can be done on both left and right thoractomy at 5th intercostal space
sx site for Caudal lung lobectomy -
both right and left
thoracotomy at 7th intercostal space
sx site for Thoracic duct in cats
left lateral thoracotomy at 8th intercostal space
right lateral thoracotomy at 4th intercostal space is used to?
- esophageal fb
- cardiopulmonary bypass
sx thoracotomy approach to thoracic duct of cats
8th intercostal on the left
sx thoractomy approach for the caudal esophagus
left lateral at 9interspace
discribe the sx procedure for left lateral thoracotomy
- sharply incise skin,subq tissue,and cutaneous trunchi mm.
deepen the incision thru the laticimus dorsi mm. with scissors
transect the scalenius,pectoral, serratusventralis,and intercostal mm
discuss closure of lateral thoracotomy
place thoracostomy tube
Preplace sutures around ribs and tie
Routine closure of musculature
DO NOT SUTURE INTERCOSTAL MM
CLOSE CUTANEOUS TRUNCI WITH SUBQ IN SMALL PATIENTS
DO NOT OVERLAP RIBS
Close cutaneous trunci with subcutaneous
tissue in small patients
Routine closure of skin
things to avoid while closing the lateral thoracotomy
DO NOT SUTURE INTERCOSTAL MM
CLOSE CUTANEOUS TRUNCI WITH SUBQ IN SMALL PATIENTS
DO NOT OVERLAP RIBS
discuss Thoracostomy Tube Placement
Stab incision in skin and subcutaneous
tissue 2-3 intercostal spaces dorsal and
caudal to thoracotomy incision
Tunnel cranially 1-2 intercostal spaces,
enter pleural space, position tube in thorax
Place purse-string or chinese finger-trap
suture in skin around tube
discuss post operative care for thoracic tube placement
Maintain chest tube until pleural
space is “free” of air and fluid
Analgesia
Intercostal nerve blocks
Narcotic analgesics
Intrapleural Bupivacaine
indications for median stenoctomy
Access to entire lung field for
exploratory surgery
Subtotal pericardectomy
Aortic valve replacement
discuss closure of median sternotomy
- Thoracostomy tube (s) placed
- Sternebrae closed with orthopedic wire
- Remaining tissues closed routinely
thoracostomy tube placement in median thoracotomy
- Stab incision over 7th-9th intercostal space
- Tunnel cranially 1-2 spaces to enter pleural
cavity
advantages of median thoracotomy
access to entire thoracic cavity
disadvantages of median stenoctomy
More lengthy and more difficult procedure
Increased morbidity
More severe postoperative pain
More severe physical dysfunction -
patient may be unable to ambulate
without assistance
