Page 160 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 11 · Thoracic wall anatomy and surgical approaches

Stabilization of a flail chest segment is most simply intercostal thoracotomy can be performed by extending the
achieved by placement of an external splint with transcu- muscle incisions at this level, therefore allowing inspection
VetBooks.ir stabilizing them to the surrounding chest wall (McAnulty, must be obtained for bacteriological culture prior to closure
of the thoracic cavity, debridement and lavage. Samples
taneous sutures encircling the ‘floating’ rib segments and
of the wound, and a thoracostomy tube and wound drain
1995). However, specific treatment of a flail chest is not
always required, and it is essential that adequate drainage
extensive trauma to the thoracic wall may have created a
of the pleural space has been performed and that the should be placed (Figure 11.23). In some circumstances,
patient has received adequate analgesia; one study failed defect necessitating thoracic wall reconstruction; owing to
to demonstrate any difference in outcome in patients with the risk of infection, use of autogenous tissue is preferred.
or without stabilization of the chest wall (Olsen et al., 2002).
Bite wounds produce a combination of penetrating Pectus excavatum
wounds, allowing inoculation of bacteria into the wound,
and deep tissue trauma, with extensive crushing injury Pectus excavatum refers to a developmental abnormality
compromising muscle viability. The appearance of a small in which the caudal sternum is deviated dorsally, therefore
bite mark on the skin surface often belies extensive injury reducing the volume of the thoracic cavity and sometimes
beneath; therefore, it is important that bite wounds, in par- compressing the heart. This condition is seen rarely; it
ticular those over the thoracic cavity, are thoroughly investi- affects cats more often than dogs. When this deformity
gated, which requires surgical exploration (Scheepens et is marked, significant compromise of ventilatory function
al., 2006). Surgical exploration is performed by extending may be present and surgical correction may be
the skin wound at the site of the injury. This approach will warranted. Surgical correction is achieved by placement
often reveal more extensive injury to underlying muscle; an of an external splint (Yoon et al., 2008; Figure 11.24), under

(a) (b)

(d) (e)

(c) (f)
Surgical exploration of thoracic bite wounds in a cat. (a) Minor skin wounds are evident over the thoracic cavity. (b, c) Thoracic radiographs
11.23
reveal subcutaneous emphysema and mild pneumothorax. (d) Surgical exploration is performed by extending the skin incision dorsoventrally.
(e) Intercostal muscle laceration and penetration of the thoracic cavity are revealed. (f) Following lavage, debridement and repair, the wound is closed
with a thoracostomy tube and wound drain in place.

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