c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Penetrating Thoracic Trauma: 10

A D V E R T I S E M E N T

   
 

If injury is so severe that primary repair cannot be accomplished while maintaining systemic perfusion, cardiopulmonary bypass (see CABG) may be necessary.       

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Penetrating Thoracic Trauma: 11

A D V E R T I S E M E N T

   
 

The left subclavian artery is located posteriorly because of the diagonal course of the aortic arch relative to the axial plane of the chest. It is thus not easily accessible from a median sternotomy and initial control of the proximal artery is best obtained through a left thoracotomy. If proximal control is not immediately possible, the apex of the left chest should be packed while additional exposure is obtained. A balloon catheter placed retrograde through the brachial artery is a useful adjunct for proximal control.     

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Penetrating Thoracic Trauma: 12

A D V E R T I S E M E N T

   
 

Wide exposure of the left subclavian artery can be achieved with a "trap door" incision, connecting the anterolateral thoracotomy with an upper median sternotomy and a left supraclavicular incision. This incision should be used judiciously because of the high incidence of causalgia and associated brachial plexus injury. If time and the patient's condition permits, neurological status should be documented prior to surgery.      

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This page was last modified on 3/22/2002.