Pneumothorax surgery: Difference between revisions
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Revision as of 19:00, 6 June 2016
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Pneumothorax Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Pneumothorax surgery On the Web |
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American Roentgen Ray Society Images of Pneumothorax surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pneumothoraces which are too small to require tube thoracostomy and too large to leave untreated, have been aspirated with a needle to remove the pressure, although this technique is usually reserved for tension pneumothoraces.
Surgery
Larger pneumothoraces may require tube thoracostomy, also known as chest tube placement. If a thorough anesthetizing of the parietal pleura and the intercostal muscles is performed, the only major pain experienced should be either the injury that caused the pneumothorax or the re-expanding of the lung. Proper anesthetizing will come about after the needle has been inserted into the chest cavity and a negative pressure is created in the syringe. While air bubbles rise into the syringe, the needle should be pulled out of the cavity until the bubbles cease. The tip of the syringe that contains the anesthetic is now in the intercostal muscles. A proper and sizable injection should ensue. This will allow the patient to be fairly comfortable despite a hemostat or finger being inserted into the chest cavity. A tube is then inserted into the chest wall outside the lung and air is extracted using a simple one way valve or vacuum and a water valve device, depending on severity. This allows the lung to re-expand within the chest cavity. This re-expansion usually lasts for approximately 15-30 seconds depending on the size of the pneumothorax and feels as if your breath has been taken away. This response is normal and should pass fairly quickly. The pneumothorax is followed up with repeated X-rays. If the air pocket has become small enough, the vacuum drain can be clamped temporarily or removed. If during the time that the tube is still in the chest the lung manages to not contiue to collapse once suction is turned off, but will diminish if actually clamped off, a heimlich valve may be used. This flutter valve allows air and fluid in the pleural cavity to escape the pleura into a drainage bag while not letting any air or fluid back in. This method was developed by the military in order to get soldiers with lung injuries stable and out of the battle field faster. It is a rarely used medical device in treatment in patients these days, but will be used in order to allow the patient to leave the hospital.
In the situation that the chest tube does not seem to be helping the healing of the lung or if CAT scans show the presence of "blebs" on the surface of the lung orthoscopic surgery may be done in order to staple the lung closed. Two small incisions are made in the back, one for a small camera and one for the tool used to seal the lung. When finished the wound is covered with a steri-strip and bandaged up.
In case of penetrating wounds, these require attention, but generally only after the airway has been secured and a chest drain inserted. Supportive therapy may include mechanical ventilation.
Recurrent pneumothorax may require further corrective and/or preventive measures such as pleurodesis. If the pneumothorax is the result of bullae, then bullectomy (the removal or stapling of bullae or other faults in the lung) is preferred. Chemical pleurodesis is the injection of a chemical irritant that triggers an inflammatory reaction, leading to adhesion of the lung to the parietal pleura. Substances used for pleurodesis include talc, blood]], tetracycline and bleomycin. Mechanical pleurodesis does not use chemicals. The surgeon "roughs" up the inside chest wall ("parietal pleura") so the lung attaches to the wall with scar tissue. This can also include a "parietal" pleurectomy, which is the removal of the "parietal" pleura; "parietal" pleura is the serous membrane lining the inner surface of the thoracic cage and facing the "visceral" pleura, which lies all over the lung surface. Both operations can be performed using keyhole surgery to minimise discomfort to the patient.