Operations on the thoracic wall and thoracic cavity organs
27 topics with concise reviews: definitions, key facts, and class questions.
This section covers surgical interventions on the chest wall, breast, and mediastinal organs. It details both basic approaches and emergency procedures (thoracotomy, pericardiocentesis, pleural cavity drainage), as well as high-tech cardiothoracic surgeries utilizing cardiopulmonary bypass.
The material is grouped by anatomical targets. You will find step-by-step surgical techniques for the breast (opening of mastitis, sector resection, radical mastectomy), lungs and pleura (from pneumotomy to pleurectomy with decortication), as well as the esophagus (extirpation, plasty, Nissen fundoplication) and diaphragm. A separate major block is dedicated to cardiovascular surgery: cardiac wound repair, correction of congenital defects (PDA, aortic coarctation), mitral commissurotomy, CABG, and cardiac pacing.
During practical classes and exams, emergency surgery is tested most rigorously: algorithms for chest trauma, drainage rules, cardiac wound repair, and pericardiocentesis. Pay special attention to the topography of the intercostal neurovascular bundle during rib resection and thoracotomy — this is a classic exam pitfall for students.
What is the disadvantage of radial incisions in deep abscesses?
When deeply localized, they require deep tissue dissection, which is ineffective for drainage and leads to severe breast deformity.
Why must the needle pass strictly along the upper margin of the rib during chest wall puncture?
The intercostal neurovascular bundle runs along the lower margin of each rib. Puncturing along the upper margin allows safe entry into the cavity while avoiding hemorrhage and nerve damage.
In what direction is the skin incision made during sectoral resection?
The skin incision is made radially. It begins from the edge of the nipple-areolar complex and runs directly over the palpable pathological lesion.
Why is this resection specifically called "subperiosteal"?
Because before removing the bone fragment itself, surgeons carefully peel back and fully preserve the periosteum (both anterior and posterior layers). The bone is literally shelled out and removed from the resulting connective tissue "sheath".
Why is one lung excluded from ventilation during a thoracotomy?
Lung collapse on the operative side significantly increases the working space for surgical manipulations.
What is the allowable length of the bronchial stump after its transection?
The length of the stump must not exceed 5–7 mm. This is necessary to prevent the accumulation of infected mucus and the development of purulent complications in the resulting blind pouch.
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