Abdominal wall bulging after thoracic surgery, an underdiagnosed wound complication
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Complications after thoracic surgery have well been established, pain being the most prominent. Intercostal nerves are mixed type nerves combining motor and sensory functions. This notion is not consistent with the incidence of PTPS compared to the incidence of muscle paresis or paralysis. We would hypothesize that abdominal wall paresis or paralysis is underdiagnosed.
In our hospital, three patients developed abdominal wall paralysis after thoracic surgery and consequent nerve damage. Their cases are discussed, and a review of the literature was conducted concerning (intercostal) nerve damage on a cellular level, the anatomy of the intercostal nerve, prevention of intercostal nerve damage and surgical techniques.
A cellular cascade known as Wallerian degeneration and regeneration determine whether a damaged nerve can function again. The recovery of the nerve is highly dependent on the correct function of activated Schwann cells and macrophages and is related to the amount of damage that has taken place. The anatomy of the intercostal nerve makes it susceptible to injury. Retractor placement during open thoracic surgery has shown to effect compression injury and induced mechanical deformation and damage. Given the known factors of pathophysiology and anatomy, a number of preventive measures have been tested to reduce intercostal nerve damage. Several techniques have been proposed, but the most used technique, the video-assisted thoracic surgery, has been the most effective in reducing nerve damage.
Abdominal wall paralysis is an underdiagnosed complication after thoracic surgery. The amount of stress on the intercostal nerves could be reduced with less invasive techniques such as the VATS technique.
KeywordsRectus Bulging Thoracic surgery Nerve damage Paralysis
We state that no grants, financial support and technical or other assistance were used, granted or gathered to write and complete this article.
- 2.Miyazaki T, Sakai T, Tsuchiya T, Yamasaki N, Tagawa T, Mine M, Shibata Y, Nagayasu T (2010) Assessment and follow-up of intercostal nerve damage after video-assisted thoracic surgery. Eur J Cardiothorac Surg 39:1033–1039Google Scholar
- 13.Gray H, Goss CM (1973) Anatomy of the human body. Lea & Febiger, PhiladelphiaGoogle Scholar
- 16.Rogers ML, Duffy JP (2000) Surgical aspects of chronic post-thoracotomy pain. Eur J Cardiothorac Surg 18:711–716Google Scholar
- 18.Cerfolio RJ, Bryant AS, Maniscalco LM (2008) A nondivided intercostal muscle flap further reduces pain of thoracotomy: a prospective randomized trial. Ann Thorac Surg 85: 1901–1906, discussion 1906–1907Google Scholar
- 19.Cerfolio RJ, Price TN, Bryant AS, Sale Bass C, Bartolucci AA (2003) Intracostal sutures decrease the pain of thoracotomy. Ann Thorac Surg 76: 407–411, discussion 411–402Google Scholar
- 23.McKenna RJ Jr, Houck W, Fuller CB (2006) Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg 81: 421–425, discussion 425–426Google Scholar
- 25.Kirby TJ, Mack MJ, Landreneau RJ, Rice TW (1995) Lobectomy–video-assisted thoracic surgery versus muscle-sparing thoracotomy. A randomized trial. J Thorac Cardiovasc Surg 109: 997–1001, discussion 1001–1002Google Scholar
- 26.Landreneau RJ, Mack MJ, Hazelrigg SR, Naunheim K, Dowling RD, Ritter P, Magee MJ, Nunchuck S, Keenan RJ, Ferson PF (1994) Prevalence of chronic pain after pulmonary resection by thoracotomy or video-assisted thoracic surgery. J Thorac Cardiovasc Surg 107: 1079–1085, discussion 1085–1076Google Scholar