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Muscle-Sparing Skin Crease Incision Posterolateral Thoracotomies in Pediatric Patients: Our Experience
Rahul Gupta1, Praveen Mathur1, Anu Bhandari2
1Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India.
Insights
Muscle-sparing thoracotomy in pediatric patients offers better motor and aesthetic outcomes than standard muscle-cutting techniques. This approach is a viable, effective alternative, especially in resource-limited settings.
Area of Science:
- Pediatric surgery
- Thoracic surgery
- Surgical techniques
Background:
- Standard posterolateral thoracotomies in children can lead to poor motor and aesthetic outcomes, along with increased postoperative pain.
- Muscle-sparing techniques aim to mitigate these morbidities.
Purpose of the Study:
- To evaluate the outcomes of muscle-sparing skin crease incision posterolateral thoracotomies in pediatric patients.
- To compare motor, aesthetic, and analgesia outcomes with standard techniques.
Main Methods:
- Prospective observational study from January 2016 to July 2020.
- Included pediatric patients with stage 3 empyema or pulmonary hydatidosis.
- Thirty-nine patients underwent muscle-sparing posterolateral thoracotomy.
Main Results:
- Adequate surgical exposure was achieved in all cases.
- All patients with empyema underwent decortication; 5 also had bronchopleural fistula repair.
- Ultrasound confirmed muscle integrity at 4 weeks, with satisfactory motor and aesthetic outcomes reported by most patients.
Conclusions:
- Muscle-sparing skin crease incision posterolateral thoracotomy is a safe and effective alternative to standard muscle-cutting thoracotomy.
- The technique provides satisfactory exposure and good functional and aesthetic results.
- It is particularly suitable for resource-challenged environments.
Context:
Standard posterolateral muscle cutting thoracotomies in pediatric patients are associated with morbidities in terms of poor motor and esthetic outcomes and also more postoperative analgesia requirement, when compared with muscle-sparing technique.
Aims:
The aim of this study is to evaluate the outcomes of muscle-sparing skin crease incision posterolateral thoracotomies in pediatric patients in terms of abovementioned variables.
Settings And Design:
This prospective observational study was conducted over a period from January 2016 to July 2020 in a tertiary care teaching institute.
Materials And Methods:
All patients of stage 3 empyema and pulmonary hydatidosis were included in the study.
Results:
Thirty-nine patients fulfilled the inclusion criteria. There were 38 children with organized (Stage 3) empyema and one patient with bilateral lung hydatid. There were 24 males and 15 females; age ranging from 6 months to 15 years. Right thoracotomy was performed in 28, left in 10, and bilateral in one patient with lung hydatid. Adequate exposure was achieved in all cases. Decortication with complete excision of thickened parietal pleura with stripping of the visceral peel and release of the entrapped lung was performed in all 38 patients. In 5 children along with decortication, repair of bronchopleural fistula due to necrotizing pneumonia was performed. Bilateral thoracotomies with pericystectomies were performed with a gap of 3 weeks for lung hydatid. Lung expansion assessment at 3 months was satisfactory. Ultrasound assessment of the latissimus dorsi muscle and serratus anterior muscle at 4 weeks revealed complete integrity in all the cases. Most of the patients achieved satisfactory motor and esthetic outcomes.
Conclusions:
Muscle-sparing skin crease incision posterolateral thoracotomy is a viable alternative to standard posterolateral muscle cutting thoracotomy, especially in a resource-challenged setting. The technique is easy to perform with satisfactory exposure.
