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RIB RESECTIONINDICATIONS & PROCEDURE                   Dane Tatarniuk, DVM
Question 1   What are the two most common indications for rib    resection?
Question 1   What are the two most common indications for rib    resection?     Pericarditis     Pleuritis   / Pleuropn...
Pericarditis   Etiology     Traumatic   reticulitis       10cm  between reticulum & pericardium       Wire, nails, etc...
Pericarditis   Pathophysiology     Bacteria  inoculation  septic inflammation       increased permeability  fluid exu...
Pericarditis   Clinical symptoms     Jugular  vein distension     Brisket edema     Submandibular edema     Cardiac a...
Pericarditis   Diagnostics     Auscultation       Splashheart beats       Muffled heart sounds     Ultrasound       ...
Pleuritis               Cows                 Pleuritiswith pyothorax or                  pleural fluid                 ...
Question 2   Do cattle have complete or incomplete    mediastinum?
Question 2   Do cattle have complete or incomplete mediastinum?       Complete   Complete mediastinum     Only lung on...
Pericarditis  Pericardiocentesis    Higher   risk    Caudal to left elbow, sternum to mid-chest    Tie left front forw...
Pericarditis              Percutaneous pericardial drain                Earlier   stages of pericarditis (mostly        ...
Thoracotomy             Standing, local lidocaine block             Incision over 5th or 6th rib             6th rib   ...
Thoracotomy   Incision started at costo-chondral    junction     Extend dorsally 20cm     Lower than CC junction       ...
Thoracotomy   Periosteum incised by scalpel   Periosteum retracted cranially & caudally with    periosteal elevators
Thoracotomy   Gigli wire placed 18cm above CC junction   Transect   Rib wide and thin   Disarticulate rib at CC junction
Thoracotomy   Incise pleura       Carefully   Exteriorize pericardium and    suture to skin edge       Same principle ...
Thoracotomy                 Post-operative                   Cover   thoracotomy site with                    sterile to...
Prognosis   Cattle     15% survival for pericarditis     71% survival for pleuritis   Horses     88% survived surgery...
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Thoracotomy in Cattle & Horses

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Thoracotomy (Rib resection) in cattle and horses for management of pericarditis and pleuritis

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  • In horses, very uncommon, but if dx, same principles apply
  • Fibrin bridges within 3 days between visceral and parietal pericardial surfaces
  • Minimal to no separation between epicardium & pericardium
  • Transcript of "Thoracotomy in Cattle & Horses"

    1. 1. RIB RESECTIONINDICATIONS & PROCEDURE Dane Tatarniuk, DVM
    2. 2. Question 1 What are the two most common indications for rib resection?
    3. 3. Question 1 What are the two most common indications for rib resection?  Pericarditis  Pleuritis / Pleuropneumonia  Pericarditismore common indication in bovine  Pleuritis more common indication in equine
    4. 4. Pericarditis Etiology  Traumatic reticulitis  10cm between reticulum & pericardium  Wire, nails, etc.  Pointed objects 5 to 14cm in length  Trauma to external chest  Cardiac neoplasia  Lymphoma
    5. 5. Pericarditis Pathophysiology  Bacteria inoculation  septic inflammation  increased permeability  fluid exudation  influx neutrophils & fibrin  Fibrin bridges within 3 days  Collagen replaces fibrin by day 6  Extensive fibrosis by 1 month  Constrictive & restrictive pericarditis
    6. 6. Pericarditis Clinical symptoms  Jugular vein distension  Brisket edema  Submandibular edema  Cardiac abnormalities
    7. 7. Pericarditis Diagnostics  Auscultation  Splashheart beats  Muffled heart sounds  Ultrasound  4-6th intercostal spaces, level of elbow  Effusion : anechoic  Exudate : granular, waving strands  Thickened sac : organized fibrin, collagen  Radiographs  Cardiomegaly appearance
    8. 8. Pleuritis  Cows  Pleuritiswith pyothorax or pleural fluid  Daily lavage, maintain drainage
    9. 9. Question 2 Do cattle have complete or incomplete mediastinum?
    10. 10. Question 2 Do cattle have complete or incomplete mediastinum?  Complete Complete mediastinum  Only lung on affected side collapses following thoracotomy  Other lung unaffected  Respiration usually stays normal Horses  Incomplete mediastinum  Walled off – then OK
    11. 11. Pericarditis  Pericardiocentesis  Higher risk  Caudal to left elbow, sternum to mid-chest  Tie left front forward  18 gauge, 6 inch needle  Slowly advance needle  Watch for needle to move synchronous with heart beat  Aspirate blood – back up  Collect fluid for cytology, culture  Rumen bacteria
    12. 12. Pericarditis  Percutaneous pericardial drain  Earlier stages of pericarditis (mostly fluid, little fibrin)  Large bore sterile chest tube  Similar insertion as for pericardiocentesis  Egress fluid continuously  Ingress lavage daily  Pull tube once fluid flushes clear
    13. 13. Thoracotomy  Standing, local lidocaine block  Incision over 5th or 6th rib  6th rib  Preferred - posterior to shoulder  5th rib  Adductionof limb during movement  Subcutaneous air under forearm, scapula  More prone to cellulitis
    14. 14. Thoracotomy Incision started at costo-chondral junction  Extend dorsally 20cm  Lower than CC junction  Lateral thoracic artery & vein Overlying thoracic muscles incised  Dorsally  Latissimus dorsi muscle  Serratus ventralis muscle  Ventrally  Pectoralis profundus muscle  Aponeurosis of obliquus externus abdominis muscle
    15. 15. Thoracotomy Periosteum incised by scalpel Periosteum retracted cranially & caudally with periosteal elevators
    16. 16. Thoracotomy Gigli wire placed 18cm above CC junction Transect Rib wide and thin Disarticulate rib at CC junction
    17. 17. Thoracotomy Incise pleura  Carefully Exteriorize pericardium and suture to skin edge  Same principle as rumenostomy Can drain pericardial fluid with needle, suction Incise pericardial sac Manually remove fibrin, clots Lavage sac liberally with saline Leave open or close with drain
    18. 18. Thoracotomy  Post-operative  Cover thoracotomy site with sterile towel or combine roll  Held in place with umbilical tape  Broad spectrum antibiotics  Incision examined, flushed daily  Wound kept open as long as fetid material egresses  Can take wound up to 1 month to close
    19. 19. Prognosis Cattle  15% survival for pericarditis  71% survival for pleuritis Horses  88% survived surgery  46% returned to intended use
    20. 20. QUESTIONS ?
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