Abdominal wall bulging after thoracic surgery, an underdiagnosed wound complication
L Timmermans1, P J Klitsie, A P W M Maat
1Department of Surgery, Erasmus MC Rotterdam, 's Gravendijkwal 230, Room Z-835, 3015 CE, Rotterdam, The Netherlands. l.timmermans@erasmusmc.nl
Hernia : the Journal of Hernias and Abdominal Wall Surgery
|August 21, 2012
Summary
Abdominal wall paralysis is an underdiagnosed complication following thoracic surgery. Minimally invasive video-assisted thoracic surgery (VATS) can reduce intercostal nerve damage and prevent this condition.
Area of Science:
- Neurology
- Thoracic Surgery
- Regenerative Medicine
Background:
- Post-thoracic surgery complications, particularly pain, are well-documented.
- Intercostal nerves, crucial for motor and sensory functions, are susceptible to damage during thoracic procedures.
- The incidence of post-thoracic surgery syndrome (PTPS) is inconsistent with muscle paresis rates, suggesting underdiagnosis of abdominal wall paralysis.
Observation:
- Three patients developed abdominal wall paralysis post-thoracic surgery due to nerve damage.
- Literature review focused on cellular nerve damage, intercostal nerve anatomy, prevention strategies, and surgical techniques.
- Wallerian degeneration and regeneration, influenced by Schwann cells and macrophages, dictate nerve recovery potential.
Findings:
- Intercostal nerve anatomy predisposes it to injury, especially from retractor placement during open thoracic surgery.
- Video-assisted thoracic surgery (VATS) has proven most effective in minimizing nerve damage compared to other proposed techniques.
- Abdominal wall paralysis is likely an underdiagnosed complication of thoracic surgery.
Implications:
- Reducing mechanical stress on intercostal nerves is crucial for preventing post-surgical complications.
- Adoption of less invasive surgical techniques like VATS can mitigate the risk of nerve damage and subsequent paralysis.
- Further investigation into the underdiagnosis of abdominal wall paralysis is warranted.
Related Concept Videos
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
01:24Healing II: Complications
Complications during healing arise when tissue repair is altered by local or systemic factors. These changes involve abnormal collagen deposition, altered biomechanics, and reduced vascular supply, impairing restoration of normal structure and function.Loss of FunctionScar tissue differs significantly from the original tissue it replaces. In the skin, fibrosis lacks adnexal structures such as hair follicles, sebaceous glands, and sweat glands. Their absence reduces tactile sensitivity, impairs...
01:08Pneumothorax II: Pathophysiology
Pneumothorax means the presence of air in the pleural space — the thin potential gap between the visceral and parietal pleura. This condition disrupts the normal pressure balance that keeps the lungs inflated, leading to partial or complete collapse of the affected lung.Normal physiologyUnder normal conditions, the pleural space maintains a slightly negative intrapleural pressure, which keeps the lungs expanded against the chest wall. This negative pressure creates a delicate balance between...
01:07Intestinal Obstruction II: Pathophysiology
Intestinal obstruction triggers a series of physiological responses, starting with gas and fluid accumulation in the bowel segment proximal to the obstruction, leading to distension. This distended intestine compresses the diaphragm, hindering lung expansion and potentially leading to reduced respiratory effort, atelectasis, and pneumonia.To overcome the blockage, the gut intensifies contractions, causing colicky abdominal pain, nausea, and vomiting, which reduces fluid and food intake and...
01:24Flail Chest-I
Overview of Flail Chest
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
01:27Pneumothorax-II
Pneumothorax is a medical condition defined by the buildup of air in the pleural space between the lungs and the chest wall. This accumulation of air can lead to partial or complete lung collapse, resulting in a range of clinical manifestations. Understanding the clinical presentation and effective management strategies is crucial for healthcare professionals in providing timely and appropriate care to individuals with pneumothorax.
Clinical Manifestations:
Clinical Manifestations: