Page 159 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery

Postoperative pleural effusion and peripheral oedema Thoracic wall trauma
are uncommon complications. These complications were Thoracic wall injury may be caused by blunt trauma in a
VetBooks.ir (9.3%), but resolved without specific treatment in all five road traffic accident or a fall from a height, impalement
reported in five of 54 dogs in one retrospective series
injuries or, most commonly, bite wounds from a larger dog
dogs (Pirkey-Erhart et al., 1995). In contrast, three of 42
(Figure 11.22). Blunt trauma may result in rib fracture, pneu-
dogs (7.1%) developed pleural effusion in another study, and
these did not resolve spontaneously (Liptak et al., 2008a). mothorax, haemothorax, pulmonary contusions and dia-
One dog died as a result of haemothorax secondary to dis- phragmatic rupture. If multiple rib fractures are present a
ruption of the internal thoracic artery, and two dogs devel- flail chest may occur, in which a segment of the chest wall
oped a serosanguineous pleural effusion secondary to is drawn in during inspiration, thereby reducing thoracic
pleuritis because of a large surface area of contact between volume and efficiency of ventilation (see Flail chest in a
the lungs and Marlex mesh following large sternal recon- dog video clip). Pseudo-flail chest occurs when there is
structions (Figure 11.21) (Liptak et al., 2008a). Furthermore, one or more sites of intercostal muscle avulsion, without
these dogs also developed subcutaneous oedema because multiple segmental rib fractures. Whilst the paradoxical
Marlex mesh is not impervious to fluids and the accumula- movement of the thoracic wall in either flail or pseudo flail
tion of large amounts of pleural fluid early in the postopera- chest does not alone substantially compromise ventilation,
tive period resulted in the flow of pleural fluid through the concurrent hypoventilation associated with pain and venti-
mesh into dependent subcutaneous spaces (Liptak et al., lation–perfusion mismatch from associated pulmonary
2008a). For dogs in which large sternal resections are contusions can cause hypoxia (Cappello et al., 1995).
planned, composite reconstructions are recommended with Patient stabilization is a priority, with provision of supple-
prosthetic mesh and well vascularized autogenous tissue, mental oxygen, anal gesia, intravenous fluid therapy or
such as omental pedicle grafts on the pleural surface or transfusion of blood products as required, and thoraco-
muscle flaps on either the pleural or lateral surface of the centesis. In severe cases, it may be necessary to perform
mesh (Liptak et al., 2008a). emergency intubation to obtain control of ventilation.

(a)

(a)

(b)
(a) A chest wall defect following resection of a sternal
11.21
haemangiosarcoma, which included six sternebrae and
approximately 50% of the associated six ribs left and right of the sternum.
(b) This large chest wall and sternal defect was reconstructed with a (b)
prosthetic Marlex mesh because autogenous reconstruction was not
possible. However, the large surface area of the lungs in contact with the Bite wounds to the chest following an attack on a Chihuahua
prosthetic mesh resulted in pleuritis and subse uent pleural effusion. To 11.22 by a larger dog. (a) Lateral thoracic view and (b) dorsoventral
minimize the risk of this complication, an omental pedicle graft should be view of the thorax. These radiographs of a Chihuahua reveal fracture of
considered on the pleural surface of the mesh (see Figure 11.16). the fifth and si th ribs pneumothora and subcutaneous emphysema.

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