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Tobias full > Thoracic wall > Flashcards

Thoracic wall Flashcards

1
Q

Wha flaps can be based on the thoracodorsal artery?

A
  • Thoracodorsal axial pattern flap
  • Composite musculocutaneous flap incorporating latissimus dorsi
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2
Q

What muscle attaches to the manubrium?

A

Sternocephalicus muscle

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3
Q

What can be used as landmarks during an IC thoracotomy?

A
  • Ribs - finger can be placed uder latissimus to count back from first rib
  • Scalenus - attached to 5th rib
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4
Q

What muscle is a landmark for the internal thoracic artery?

A

Transverse thoracic muscle (travels dorsal to muscle)

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5
Q

How many intercostal arteries are present?

A

12 (ribs 1-12)

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6
Q

Where do the internal thoracic arteries arise from?

A

Left and right subclavian arteries

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7
Q

What structures can be damaged during a cranial median sternotomy?

A
  • The brachiocephalic truncks and cranial vena cava (Sit right below the sternum and can become collapse during retraction resembling connective tissue)
  • Brachiocephalic trunks form from the internal jugular vein and brachial vein. Brachiocephalic trunks then combine to form cranial vena cava in cranial mediastinum
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8
Q

What form of IC thoracotomy closure has been associated with less post-op pain?

A
  • Transcostal suture rather than circumcostal
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9
Q

List options for approaching the thorax

A
  • Intercostal thoracotomy
  • Rib resection thoracotomy
  • Median sternotomy
  • Xiphoid resection thoracotomy
  • Transsternal thoracotomy
  • Transdiaphragmatic thoracotomy
  • Paracostal approach
  • Thoracoscopy
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10
Q

What vessels will be encountered during approach for a median sternotomy?

A
  • Perforating branches of the internal thoracic artery and vein when seperating the pectoral muscles
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11
Q

What instruments can be used to perform a median sternotomy?

A
  • Reciprocating saw
  • Osteotome
  • Special sternal saw
  • Sternal splitter
  • Bone cutters
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12
Q

Where are the sternal LNs located?

A

Where the internal thoracic arteries meet the transverse thoracic muscle

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13
Q

Why is an alternating figure-of-8 pattern beneficial for closure of the sternum?

A
  • Avoids distraction of the dorsal or ventral edge
  • Maximises boney contact
  • Reduces pain
  • Facilitates healing
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14
Q

What vessels may bleed during a transdiaphragmatic thoracotomy?

A

Branches of the phrenic artery

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15
Q

What can the paracostal approach be used for?

A
  • Right sided for accessing thoracic duct, cisterna chyli and aorta
  • Adrenalectomy
  • Migrating FBs for abdominal and thoracic exploration
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16
Q

What are the 2 broad options for thoracoscopy?

A
  • Intercostal
  • Paraxyphoid
17
Q

What breeds are predisposed to pectus excavatum?

A
  • Burmese and Bengal cats

Sternum and caudal ribs fail to gro normally, possible due to shortened or hypoplastic diaphragm, resulting in concave abnormality of the caudal sternebrae

18
Q

How is pectus excavatum treated?

A
  • External splinting in young animal with compliant sternebrae
  • Older animals may need an internal splint (VCP) or osteotomy of deformed sternebrae and costochondral junctions with external splinting
19
Q

In what breed has a sternal cleft been described?
Along with what other congenital defects?

A
  • GSD
  • With PPDH and cranial abdominal hernia
20
Q

What is a “step” sign on TFAST?

A

Indicates a discontinuity of the parietal pleura. Can signify IC muscle tear or rib fracture

21
Q

In what animals with thoracic bite wounds should surgery be recommended?

A

All those with rib fractures, pulm contusion or pneumothorax (according to a study)

Ongoing haemorrhage, pneumothorax or sepsis are indications for surgical exploration

22
Q

How can multiple laceration of the IC muscles be apposed?

A

Basket-weave pattern

23
Q

List the most common thoracic wall neoplasias

A
  • Chondrosarcoma
  • OSA
  • FSA
  • Other spindle cell tumours (haemangiopericytoma, PNST, Schwannoma)
  • HSA infrequent
  • MST
24
Q

What are the recommended margins for thoracic wall tumours?

A

At least 3cm

25
Q

What is considered the maximum thoracic wall resection for adequate reconstruction?

A

6 ribs

26
Q

List options for sternal reconstruction

A
  • Deep pectoral muscle flaps
  • Sanwiches of mesh and PMMA
  • Kiel bone
27
Q

What muscle flaps can be used for thoracic wall reconstruction?

A
  • Latissimus dorsi
  • External abdominal oblique
  • Transversus abdominis
  • Diaphragmatic advancement (ribs 8-13) (may require caudal lung lobectomy)
28
Q

List options for reconstruction with commercial products

A
  • Polypropylene mesh
  • PTFE mesh/sheet ($$, strong and occlusive)
  • Polyglactin mesh (absorbable, good for infected sites)
  • Porcine SIS

Infection rates with polypropylene mesh 0-5.7%. Can be minimised by covering with well vascularised tissue (omentum, muscle)

29
Q

How often should the thoracostomy tube be suctioned in the post-op period?
When is pleural effusion most common after thoracic wall reconstruction?

A
  • Suctioned every hour until 3 consecutive negative results have been obtained. Then every 4 hours for 12 hours
  • Pleural effusion after reconstruction within forst 48hr and then declines sharply within 4-5 days

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