The intercostals muscles, serratus anterior, pectoralis major, and latissimus dorsi, are established workhorse flaps used in most chest wall reconstructions. These flaps are reliable and simple. Less frequently, alternative pedicle flaps may be employed: rectus abdominis muscle, fatty or musculocutaneous flaps, thus it may justify a simple overview.
Rectus Abdominis
The rectus abdominis are thick and triangular muscles that extend from the pubic tubercle and arch of the pelvis, to the xiphod process of the sternum, and cartilage of 5th to 7th rib. The use of this flap is based on the ease of dissection and the wide arc of rotation of the rectus abdominis muscle.
The muscle enter the chest through either a subcutaneous tunnel or via the diaphragm. The length and bulk of a pedicled rectus abdominis flap can reach and obliterate and infected plural space as high as to the sternal notch. Intrathoracic mobilization is possible based on the superior epigastric vessels, which continue the internal thoracic ones.
Unfortunately, rectus abdominis muscle, as the omental flap would entail a separate abdominal wound. Furthermore, its use may result in hernia formation or substantial deformity of the abdominal wall in thin or malnourished patients.8
Omentum
The greater omentum has many properties that make it valuable in chest wall reconstruction. This organ not only has a potential ability to revascularize organs to which it is attached, but also is rich in macrophages and localizes infection, even in heterotopic setting. 18,31
The pliability and bulkiness of the tissue makes it suitable for filling irregular spaces and reaching relatively inaccessible locations. The omentum flap is mobile and large enough to fill a extensive wound cavit...
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...t-tissue band representing the cutaneous portion of the flap.3
The contrast enhancement and fluorine 18 fluorodeoxyglucose (FDG) of the soft-tissue component in muscle flaps is similar to that of other muscular structures. 3 Increasing muscle mass, areas of increased enhancement or fluorine 18-FDG uptake are worrisome for recurrence of cancer or infection in the flap.27 However, heavily calcified intercostals muscle flap can show uptake of fluorine 18-fluorodeoxyglucose (FDG) similar to that in bone, mimicking recurrent malignancy.3 15
COMPLICATIONS OF THE FLAP
In successful closure of intrathoracic defects, the inflammatory process decreases gradually. The pleura is pulled toward the thoracic wall, and the residual lung expands.29 There is risk of partial cavity recurrence when severe destruction caused by fibrosis and adhesions prevents the surrounding lung to expand.11
The contraction of the inspiratory muscles increases the volume of the thoracic cavity causing the pressure within the alveoli to decrease and air to flow into the alveoli. During resting inspiration, the diaphragm, the external intercostals and the parasternal intercostals contract to stimulate inspiration. During forced inspiration the scalene and the sternocleidomastoid muscles contract to further expand the thoracic cavity. The pectoralis minor muscles also play a minor role in forced inspiration. During quiet breathing, relaxation of these muscles causes the volume of the thoracic cavity to decrease, resulting in expiration. During a forced expiration, the compression of the chest cavity is increased by contraction of the internal intercostal muscles and various abdominal
Imaging: CT scan of the chest dated September 2, 2015, which was personally reviewed demonstrates a subpleural opacity at the right lung apex, which appears to have decreased in size since the last study. The small subpleural opacity of the medial right lung apex with a predominately band like configuration is decreased in size since the last study measuring approximately 1.7 x 0.5 cm in the axial plane on axial imaging 19 previously measuring 1.8 x 0.7 cm. They are certainly a qualitative decrease as well.
Millions of people suffer from heart valve disease every year (“US Markets for Heart Valves”, 2007). Out of all of the heart valve diseases, “mitral regurgitation is the second most common valvular heart disease” (Baumgartner et al., 2006). This is due to the fact that the mitral valve experiences the most pressure and blood flow compared to the other valves in the heart (“US Markets for Heart Valves”, 2007). The disease occurs when blood leaks back into the left auricle from the left ventricle, which is caused by the mitral valve not closing properly (Lantada et al., 2009). The majority of the time, the mitral valve does not function correctly due to a structural abnormality (Buckner et al., 2010). These abnormalities can occur in either the papillary chords or the papillary muscles (Lantada et al., 2009). The frequency of the mitral valve abnormalities, especially in the elderly population, led to extensive research to find a solution (“US Markets for Heart Valves”, 2007).
Sinus cavity and extraction sockets were totally excluded from this classification because the healing process h...
Pritesh has a previous medical history of asthma and has experienced right-sided haemothorax as he got hit by a hockey ball during a competition. Currently, the nurse suspects that Prithesh may be developing tension pneumothorax which is a life-threatening medical emergency (Brown & Edwards, 2012). Tension pneumothorax develops when a hole in the airway structures or the chest wall allows air to enter but not leave the thoracic cavity (Rodgers, 2008). The pressure in the intrathoracic space will continue increase until the lung collapses, place tension on the heart and the opposite lung leading to respiratory and cardiac function impairment, and eventually shock may result (Professional guide to pathophysiology, 2011; Rodgers, 2008). Tension pneumothorax usually results from a penetrating injury to the chest, blunt trauma to the chest, or during use of a mechanical ventilator (Brown & Edwards, 2012; Rodgers, 2008).
James’s biopsy of his right gastrocnemius muscle would have shown a degeneration of the muscle or skeletal fibers due to the lack of dystrophyn. Another microscopic change that would be noticed is the accumulation of white blood cells. White blood cells have a very specific function which is to clear the damaged muscle fibers from the debris. Clearly, due to some of the muscle fibers being damaged other healthy fibers that have not been damaged appear denser. By having damaged muscle fibers, all the work rest upon the healthy fibers making them contract to the fullest due to the fact that the myosin and acting would have to overlap even more to make the muscle work.
If there is not enough tissue for the reconstruction, the surgeon will insert a tissue expander under the skin and gradually fill it with saline solution, causing the skin to stretch and grow. Eventually, there will be enough room for the implant. Then reconstruction surgery can proceed. The surgeon will make a small incision and insert the implant.
Tension Pneumothorax requires immediate attention. A needle or chest tube needs to be inserted into the chest cavity to release the pressure as soon as possible. If an evacuation is going to take a long period of time you may have to do this procedure yourself. That is not recommended though.
...gs causing high pressure in the arteries; leading to an irreversible pulmonary hypertension. Other complications include, “aortic insufficiency, leaking of the valve that separates the left ventricle from the aorta; damage to the electrical conduction system of the heart during surgery causing an irregular heart rhythm; delayed growth and development; heart failure; stroke; infective endocarditis, a bacterial infection of the heart.”
...he site of destruction and regrow those damaged cells. This could be a medical breakthrough for many patients because this could mean limited hospital stay; Fewer treatments from reoccurring illness caused by damaged tissue and saving them money by decreasing the need for multiple hospital visits.
Mink Intro – External Anatomy Overview. (n.d.). mreroh.com . Retrieved May 27, 2014, from http://www.mreroh.com/student/apdocs/Dissection/Intro%20-%20External%20Anatomy.pdf
However, these side effects can be avoided with the proper amount of vitamin and mineral supplements. Up to 20 percent of patients who undergo the operation will require follow-up surgeries to correct complications. Common problems include abdominal hernias, breakdown of the staple line and stretched stomach outlets. There’s rapid regain of weight and all sorts of medical problems. From vitamin deficiencies to constant illness, stomach upsets, diarrhea, fatigue and horrible wound infections. Many people don’t want to admit they’ve had problems because they’re so happy to be thin; “People who have had the surgery the past couple of years are in a honeymoon state”, states Guthrie, Catherine. The author of “Bariatric Surgery: A Radical Obesity Fix. They is so thrilled to be thin. They believe being thin at all costs is more important than their own lives. Even if the patients have problems although these are some complications, most patients undergo only one surgery and there's an 85 percent success rate.
Rectus, and External and Internal Obliques flex the spine. Transversus aids in respiration and helps to compress the abdominal cavity to help support the spine in neutral. 4. How does the breath relate to flexion and extension of the spine?
Chronic bronchitis is a disorder that causes inflammation to the airway, mainly the bronchial tubules. It produces a chronic cough that lasts three consecutive months for more than two successive years (Vijayan,2013). Chronic Bronchitis is a member of the COPD family and is prominently seen in cigarette smokers. Other factors such as air pollutants, Asbestos, and working in coal mines contributes to inflammation. Once the irritant comes in contact with the mucosa of the bronchi it alters the composition causing hyperplasia of the glands and producing excessive sputum (Viayan,2013). Goblet cells also enlarge to contribute to the excessive secretion of sputum. This effects the cilia that carry out the mechanism of trapping foreign bodies to allow it to be expelled in the sputum, which are now damaged by the irritant making it impossible for the person to clear their airway. Since the mechanism of airway clearance is ineffective, the secretion builds up a thickened wall of the bronchioles causing constriction and increasing the work of breathing. The excessive build up of mucous could set up pneumonia. The alveoli are also damaged enabling the macrophages to eliminate bacteria putting the patient at risk for acquiring an infection.
A tension pneumothorax can be caused by a blunt or penetrating trauma, in the case study provided it would be a blunt trauma. The trauma to the chest area causes damage to the plural cavity; either the visceral (lines either lung) or parietal plura (lines the thoracic wall), or can be caused by trauma to the traceobronchial tree (Daley, 2014). The trauma to the chest area causes the formation of a one-way-valve, this allows for the air to flow into the plural space on inhalation, but on exhalation cannot be expelled (Curtis, Ramsden, & Lord, 2011). As the trapped air in the lungs build up within the affected side it can cause serious complications. In the case study it is the left lung that is in distress, and as the pressure increases within the left lung it can cause an impaired venus return to the right atrium (Daley, 2014). The increased pressure can eventually affect the right lung as the pressure builds in the left side and causes mediastinal shift which increases pressure on the right lung, which decreases the patients ability to breath, and diffuse the bodies tissues appropriately. The increase in pressure on the left side where the original traum...