Page 156 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 11 · Thoracic wall anatomy and surgical approaches

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(a)

(a)

(b)
(a) A caudal rib tumour has been excised and the chest wall
11.16 has been reconstructed by advancing the diaphragm. The
resultant abdominal wall defect has initially been reconstructed with
an omental pedicle graft with the omentum sutured to the edges of
the abdominal and chest wall defect. Omentum should not be used for
primary reconstruction of chest wall defects. In this case, the
omentum will cover the peritoneal aspect of the prosthetic mesh
reconstruction of the abdominal and chest wall defect.
(b) Reconstruction of the chest and abdominal wall defect is
completed by suturing prosthetic mesh into the defect with a simple (b)
continuous suture pattern over the omental pedicle graft. The omental
pedicle graft should reduce pleural and peritoneal inflammation and
promote healing and incorporation of the prosthetic mesh.

are ligated and transected to allow caudal retraction of the
visceral leaf. An inverted L-shaped incision is then made.
Omental vessels are ligated along the left border of the
greater omentum caudal to the gastrosplenic ligament and
the omental incision is then continued caudally parallel to
the remaining omental vessels for two-thirds of its length.
The epiploic branches to the greater curvature of the
stomach and the opposite gastroepiploic artery are ligated
and divided. The omental pedicle graft can then be
extended into the thoracic cavity, either through the dia-
phragm if a median sternotomy has been performed or
through a subcutaneous tunnel via a paracostal incision if
a lateral intercostal thoracotomy has been performed. The
abdominal exit site should be as close as possible to
the origin of the omental pedicle graft and large enough (c)
to prevent vascular compromise of the omental pedicle
graft (Ross and Pardo, 1993). 11.17 (a) The chest and abdominal wall defect resulting from
resection of a caudal rib osteosarcoma. Following caudal rib
resections, the thoracic cavity can be restored by advancing the
Diaphragmatic advancement: Chest wall defects involving diaphragm (D) rather than reconstruction of the chest wall. (b) The free
the ninth to 13th ribs do not necessarily require reconstruc- edge of the diaphragm is advanced and sutured to the edge of the chest
tion as normal thoracic physiology and function can be wall resection with a simple interrupted (depicted) or continuous suture
restored by advancing the diaphragm cranially. Following pattern. (c) The diaphragm has been advanced to restore normal
resection of a caudal chest wall tumour, the free edge of the thoracic function and physiology. Note the temporary thoracostomy
tube arro ed hich is used to evacuate air and fluid from the thoracic
diaphragm is sutured to the ribs and chest wall defect with cavity intraoperatively and is removed once negative intrathoracic
absorbable suture material in either a continuous or inter- pressure has been established. The resultant abdominal wall defect is
rupted suture pattern (Figure 11.17). Rarely, caudal lung then reconstructed using autogenous and/or prosthetic techniques (see
lobectomy may be required to allow sufficient intrathoracic Figure 11.1 . B abdominal cavity L lungs.

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