Muscle plastic residual cavity and bronchial fistula
Pulmonology / / May 02, 2016
Operations on chest wall and chest cavity
(method of operation)
course of operations.
1. Access. Two crescent bordering incision 10-15 cm was excised skin and scar tissue around the fistula at a distance of 2-3 cm from the mouth.At this stage the operation takes sister chetyrehzubye sharp hooks and small cotton swab on short clips (see illustration).The edges of the wound sheathe large towels after the surgeon finally determine the size and direction of the surgical wound, taking into account the choice of the muscles that will be used for plastics.If the residual cavity of sufficiently large size, then over her resected segments of one or more ribs (see. "Subperiosteal resection of the ribs").After resection of the rib or ribs, chest wall over the remaining cavity becomes pliable.
Plastic residual cavity and bronchial fistulas
2. Preparation of the residual cavity. sister surgeon delivers large cotton swab moistened for processing residual cavity walls;hydrogen peroxide, and then -
3. Elimination of bronchial fistulas. Pointed scalpel surgeon excised the mouth of the bronchial fistula, an opening on the medial wall of the cavity.To pull out the mouth of the fistula surgeon is necessary to apply the clamp type or Mikulic Kocher.Otseparovav fistula on the greatest possible depth, the surgeon sews it and bandages.To do this, prepare a small seam responsible knuckle thread the needle with Mylar on a long needle holder.After ligation of the fistula mouth it was excised.Over the fistula is applied to lung tissue mattress suture.The walls of the cavity again treated with iodine.Sister removes from the table all the tools used, changing linens and lays out a new set of tools.The whole team is changing gloves.
4. Muscle plastic residual cavity. Depending on the location of the fistula incision extend in the direction of the pectoralis major muscles in front or to the latissimus dorsi muscle - posteriorly.bryushisty use a scalpel (see the figure) for cutting out the flap size.Crossed vessels ligated catgut.The free end of the flap is immersed into the cavity so that it without tension reached its bottom and filled the whole of its volume.The edges of the flap is sutured to the walls of the cavity catgut №6.
5. Drainage cavity. for drainage cavity should be prepared silicone tube diameter of 5-6 mm.The surgeon puts it at the bottom of the cavity next to the flap and through a separate incision outputs.Drain fixed to the skin with a thick silk (see illustration).
6. stitching wounds. skin was sutured with silk sutures №3 throughout the surgical wound.
7. Imposition of bandages. skin around the wound is treated with alcohol and iodine.Then impose a cotton-gauze sterile dressing.If there was resected several ribs and chest wall sinks into after the operation, it is advisable to lay the roller bandage, and not very tight bandage to his chest wall for better fixation of the muscle flap to the bottom of the cavity, but without squeezing it.