Page 165 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

eline Head,
Neck and
V
A Manual of Canine and F
Thoracic Surger
BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery
y
BSA
➜ OPERATIVE TECHNIQUE 11.1 CONTINUED
VetBooks.ir 7 The intercostal thoracotomy incision is closed
with either circumcostal or transcostal sutures.
The traditional circumcostal suture technique
involves preplacing large-gauge (3 to 5 metric
(2/0 to 2 USP) depending on the size of the
animal) absorbable or non-absorbable suture
material around the cranial and caudal ribs in
either a simple interrupted or cruciate suture
pattern. The needle should be passed as close as
possible to the ribs to avoid entrapping soft
tissues between the suture material and the ribs.
For the transcostal technique, holes are drilled in
the mid-body of the caudal rib (see Figure 11.4a)
so that the suture material is passed through the
rib rather than around the rib, thus avoiding
entrapment of the intercostal nerve (see Figure
11.4b). Regardless of whether a circumcostal or
transcostal technique is used, the preplaced
sutures are used by an assistant to approximate
the ribs while the surgeon ties the sutures.

8 The serratus ventralis, scalenus, external abdominal oblique, latissimus dorsi and cutaneous trunci muscles are
closed individually with either interrupted or continuous suture patterns to prevent air leakage postoperatively.
Following routine closure of the subcutaneous layer and skin, the thoracostomy tube is secured with a Chinese
fingertrap suture pattern.

POSTOPERATIVE CARE
The thoracic cavity can be bandaged to minimize the risk of seroma formation and premature removal of the
thoracostomy tube, but care should be taken to ensure that the bandage is not applied so tightly that thoracic wall
excursion is restricted. If a temporary thoracostomy tube has been used, the thoracic cavity should be evacuated until
negative intrathoracic pressure has been re-established and the tube is then removed.
Thoracic surgery is painful and multimodal analgesia is an important consideration to decrease the doses of
anaesthetic drugs, improve recovery and decrease hospitalization times. Analgesia should be started prior to surgery.
Analgesic protocols should include pre-, intra- and postoperative CRIs of an opioid (fentanyl or morphine) either alone
or in combination with ketamine and/or lidocaine CRIs. The administration of intercostal nerve blocks may aid
postoperative analgesia. A subcutaneously implanted wound diffusion catheter is useful for the administration of local
anaesthesia (ropivacaine and/or lidocaine) for 24–48 hours postoperatively. A non-steroidal anti-inflammatory drug
should be administered for a minimum of 10–14 days postoperatively and this should be combined with a stronger oral
analgesic (such as tramadol) for a minimum of 5–7 days.

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