Explains types of thoracic surgeries and incisions used

1. THORACIC
SURGERIE
S

2. CHEST TRAUMA
 Sharp injuries
 Blunt injuries
 Medical procedures
 Falls

3. Cardiac tamponade
Pericardial effusion

4. Causes
 Blunt or penetrating trauma to the chest
 Myocardial rupture
 Cancer
 Pericarditis
 Cardiac surgical procedures / iatrogeni
trauma
 Anti coagulant therapy
 Post op bleeding

5. Pathomechanism
 Fluid can be blood or pus
 Outer surface of pericardium is comparatively
not pliable
 Excess pressure on heart
 Less blood entering the ventricles
 Decreased cardiac output

6. Classical signs
 Low blood pressure
 Decreased stroke volume
 Jugular venous distension
 Muffled heart sounds
 ST segment changes on ECG

7. Symptoms
 Chest pain
 Weak / fainting
 Breathing difficulty
 Tachypnoea

8. Investigations
 Echocardiography
 X ray – large globular heart

9. Treatment
 Oxygen therapy
 Emergency thoracotomy
 Pericardiocentecis – 5th ICS (3-5 cm lateral to
sternum) / subxiphooid approach
 Regular checking for chest tube blockages
post surgery

10. Complications
 Shock
 Arrhythmias
 Embolism

11. Rib fractures
 Chest binders for simple fractures
 For multiple fractures………..

12. Flail chest
 A segment of the thoracic cage is separated
from the rest of the chest wall
 At least two fractures per rib (producing a free
segment)

14.  Cause lung contusion
 Require mechanical ventilation

15. Diagnosis
 Bruises on the chest wall
 Crepitus on palpation
 Paradoxical movement of the chest wall in the
injured area
 Can be appreciated also on palpation
 Chest x ray

16. Complications
 Lung contusions, pneumonia
 Hemo thorax
 pneumothorax

17. Investigations
 X ray
 CT scan

18. Management
 Proper oxygenation and ventilation
 100% oxygen
 Mechanical ventilation and intubation for
contusions
 Analgesia
 NSAIDS
 Patient controlled administration of opioid infusion
 Continuous epidural infusion , local anaesthesia –
does not impede breathing movements

19.  Prophylactic ICD insertion along with
mechanical ventilation
 External fixation and stabilization

20.  Positive pressure ventilation for internal
stabilization
 Complete cardio pulmonary monitoring

21. Rib resection
 Surgical removal of the rib

22.  If can cause lung contusion
 Cancer
 For bone graft
 For thoracic outlet syndrome

23. Decortication
 Removing restrictive layer of fibrous tissue
over the lung
 For re-expansion of the lung tissue
 Pleural space disorders
 Fibro thorax – btw lung and visceral pleura
 Tuberculous empyema
 hemothorax

24. A stab to the right chest
presented 1 week later
with fever, chills, and
dyspnea. The radiograph
shows an inflammatory
process that did not drain
via a needle

25. Indications
 Initial drug therapy
 Decortication if long term drug therapy fails

26. Contraindications
 It is of no use for diseased lung which has lost
it’s pliability
 Pleural space infections
 Uncontrolled lung infections
 Patient’s nutrition status
 Sepsis
 Further Rx would be
pleuropneumoperitoneum

27. VATS(video assisted
thoracoscopic surgery)
 Similar to laproscopic surgery
 Reduced mortality with this procedure
 Extreme care has to be taken
 Anatomical considerations – heart, abdomen,
subclavian vessels, pulmonary artery, air
leaks causing pneumo peritoneum, phrenic
nerve, trachea, eosophagus, sympathetic
chain posteriorly

28. TUBERCULOSIS
 Caused by mycobacterium tuberculosis
 Weak immune system

29. Spreading of disease
 Primary
 Secondary
 Miliary

30. Symptoms
 Severe cough 3 weeeks or more
 Chest paim
 Coughing blood or sputum
 Weakness or fatigue
 Weight loss
 Loss of appetite
 Chills
 Fever
 Night sweats

31. Investigations
 X ray
 Montoux test
 Sputum examination
 Blood tests

32. Thoracocentesis/ Pleural tapping
 In pleural diorders – hemo / pyo / hydro /
pneumo/ chlyo (lymph) thorax.
 For diagnosis and treatment
 Seen in most of the chest infections in severe
stages
 Needle into the thorax – into the pleural cavity

35. Causes
 Hemorrhage
 Infection
inflammation
 Malignancy
 Iatrogenic
 Connective tissue disorders
 Nephrotic syndrome

36. Thoracotomy
 Incision into the thoracic cavity for diagnostic
procedures or for surgeries
 For lung surgeries or heart surgeries
 Or for the structure of the thoracic cavity …
anterior spine, lower eosophagus

38.  Thoracic surgeries – lobectomy,
pneumonectomy, segmentectomy, ICD
insertion, pleural cavity disorders wedge
resection etc…
 Incisions used – median sternotomy,
posterolateral thoracotomy, anterolateral,
clampshell (bilateral anterolateral)

40.  Complications – infection, resp failure,
pneumothorax, subcutaneous emphysema
 Post operative treatment – medical, PT

41. Wedge resection

42.  Lung cancer
 Fibrosed lung
 Infection
 ILD
 Blebs
 Bronchiectasis
 Pleural adhesions
 Pleurodesis

43. Investigations
 CT scan
 X rays

44. Pnemonectomy