Intercostal Thoracotomy Closure: Transcostal Sutures as a Less Painful Alternative to Circumcostal Suture Placement

Abstract

Based on lower pain scores, transcostal thoracotomy closure may be preferable to circumcostal closure techniques.

Thoracic Surgery; Important Considerations and Practical Steps

“…Sternal instability is reportedly one cause of significant discomfort in humans after sternotomy, often resulting in delayed healing and other postoperative complications. 15 Reports of delayed healing and sternal shifting as a primary complication are lacking in veterinary medicine with only a few cases of sternal fracture or osteomyelitis attributed to sternal instability. 19 On entry, transection of some mediastinal attachments and hemorrhage control are usually necessary.…”

“…An alternative technique has been reported for closure of a lateral thoracotomy. 15 A lateral to medial tunnel is drilled in the caudal rib, and the suture is passed through the tunnel. The suture is passed around the cranial rib in a routine manner.…”

Postthoracotomy Management

“…1 There is conflicting evidence regarding the surgical technique used and subsequent pain, although most clinicians believe that a median sternotomy is associated with a higher need for postoperative analgesia than a lateral thoracotomy. 5,6 Several pain control strategies are available for postthoracotomy patients. 4 Similarly, muscle-sparing approaches, alternative closure techniques for lateral thoracotomy, and the use of minimally invasive surgery are reported as methods to decrease postoperative pain.…”

Thoracoscopic foreign body removal and right middle lung lobectomy to treat pyothorax in a dog

“…However, surgery (thoracotomy) is warranted in cases of large inhaled foreign bodies and/or mediastinal or pulmonary lesions (Rooney and Monnet 2002, Scott and Macintire 2003b, Johnson and Martin 2007). Potential disadvantages associated with intercostal thoracotomy and sternotomy include wound complications, long recovery and postoperative pain (Ringwald and Birchard 1989, Pascoe and Dyson 1993, Burton and White 1996, Walsh and others 1999, Mellanby and others 2002, Dunning 2003, Orton 2003, Rooney and others 2004, Moores and others 2007).…”