Postoperative atrophy of posterolateral chest wall musculature: CT demonstration

Intercostal Lung Hernia Following Deep Inferior Epigastric Perforator Reconstruction

Acquired lung hernias typically result from trauma or intra-thoracic surgery is defined as the protrusion of lung parenchyma beyond the anatomic boundaries of the thoracic wall. A 40-year-old woman underwent deep inferior epigastric perforator (DIEP) breast reconstruction following her mastectomies. Post-operatively, she returned to the emergency department with severe chest pain, shortness of breath, and localized chest swelling. CT angiography demonstrated intercostal right lung hernia with concern for incarceration. She returned emergently to the operating room. The lung was reduced, but the flap was ultimately determined to be nonviable and was removed. Post-operative course was uneventful and the patient recovered well. Intercostal lung hernia is an uncommon clinical entity that has not previously been described as a complication of DIEP breast reconstruction. Its development is associated with significant morbidity including flap loss in this case. Early recognition of this rare complication is essential to avoid more severe sequelae of tissue ischemia.

Therapeutic strategy for thoracoscopic repair of esophageal atresia and its outcome

PURPOSE

Thoracoscopic repair can be safely performed in most types of congenital esophageal atresia (EA), including in patients with long gap EA or very low birth weight. Accordingly, we performed single- or multistage thoracoscopic repair for various EA types. We aimed to report our therapeutic strategy for thoracoscopic radical surgery for treating EA and its outcome.

METHODS

Outcomes of radical surgeries for treating congenital EA at our institute from 2013 to 2018 were retrospectively evaluated.

RESULTS

Thirty-eight radical surgeries were evaluated: 3 Gross type-A, 1 type-B, 30 type-C, 1 type-D, and 3 type-E. The cervical approach was performed in 5 cases and thoracoscopic esophageal anastomosis in 33, including 26 single-stage (all type-C) and 7 multistage surgeries (3 type-A, 3 type-C, and 1 type-D). There were no cases of thoracotomies or intraoperative thoracoscopic surgery complications. Three cases of minor leakage were conservatively resolved. Three postoperative chylothorax surgeries (9%) and seven balloon dilatations (21%) for anastomotic stenosis were performed.

CONCLUSION

Thoracoscopic radical surgery for treating EA, including single- and multistage procedures, can be performed, except in type-E cases or when the end of the proximal esophagus is located higher than the clavicle.

Thoracoscopic surgery for esophageal atresia

This review centers on the thoracoscopic management of esophageal atresia (EA) and distal tracheoesophageal fistula (TEF). The first thoracoscopic repair of EA was performed by Rothenberg and Lobe in Berlin in 1999 just prior to an IPEG meeting. Since that time, the largest report describing the use of thoracoscopy for EA/TEF repair came in 2005 with a multi-national, multi-institutional retrospective review from six institutions around the world. The outcomes reported were quite good and very comparable to large series of open operations that had been previously reported. This review will describe a single surgeon's technique for thoracoscopic repair of EA/TEF. In addition, further controversies regarding the usefulness of preoperative bronchoscopy, ligation of the distal TEF, and type of suture used for the esophageal anastomosis will also be discussed. Finally, there is a discussion on the advantages and disadvantages of the thoracoscopic approach.

Complete unilateral right-sided absence of the pectoralis major and serratus anterior muscles in an adult male cadaver of South Indian origin

The unilateral complete absence of the pectoralis major and serratus anterior muscles in the absence of other anomalies is very rare. The complete absence of the pectoralis major and serratus anterior on the right side was observed during routine dissection of an elderly male cadaver of South Indian origin. Nodularity of the right fifth rib near the fifth costochondral junction was seen. The lateral pectoral and long thoracic nerves were present on the right side. Moderate right-sided disuse atrophy was noted in the pectoralis minor and the rotator cuff muscles due to a shoulder arthrodesis performed on that side. No abnormalities were noted on the left side. There was no family history of any upper limb anomalies suggestive of Poland's syndrome. The findings in the present case could be either due to a sporadic variant of Poland's syndrome or an isolated congenital unilateral absence of the pectoralis major and serratus anterior.

Symptomatic intercostal lung hernia secondary to sternal dehiscence surgery

Patient: Male, 60

Final Diagnosis: Iatrogenic intercostal lung hernia

Symptoms: —

Medication: No medication

Clinical Procedure: Surgically cerrected

Specialty: Thoracic surgery

Muscle sparing thoracotomy in pediatric age: a comparative study with standard posterolateral thoracotomy

Alternative approaches to the standard posterolateral incision for thoracotomy have been developed to minimize its postoperative pain and wound related side effects. Muscle-sparing (MS) thoracotomy has been a well-known substitution to the standard posterolateral thoracotomy for this purpose; however it has not been studied in the pediatric age group in detail. We studied retrospectively the patients with thoracotomy for non-cardiac, thoracic surgical procedures. Group 1 included the patients with standard posterolateral thoracotomy for the surgery. The patients with MS thoracotomy composed group 2. The related data were collected retrospectively. The early postoperative morbidities (time requiring for regaining shoulder girdle movement, extubation, intensive care unit stay, and hospital stay) and late musculoskeletal anomalies (scoliosis, elevation of the shoulder, winged scapula, asymmetry of the nipples) were compared between groups. A total of 90 patients were included in the study. Group 1 constituted 50 patients with an average age of 4.24 +/- 2.91 years. Group 2 included 40 patients with an average age of 4.20 +/- 2.92 years. Comparison of the demographics and the baseline characteristics of the patients were not different between groups. In comparison of operative characteristics, there was lesser morbidity in group 2 as re-exploration for bleeding, wound infection, wound healing and fewer intensive care unit and hospital stay days. Late follow-up revealed a significant increase in musculoskeletal deformities in group 1. We conclude that muscle-sparing incision should be preferred to the standard posterolateral thoracotomy in pediatric age.

Intercostal lung hernia subsequent to harvesting of the left internal mammary artery

We report a case of an intercostal lung hernia developing subsequent to harvesting of the left internal mammary artery. Intercostal lung hernia is extremely rare, with most cases reported after blunt thoracic trauma. In the absence of symptoms, this was treated conservatively.