This document discusses thoracotomy, which is a surgical incision of the chest wall. It describes the surgical anatomy of the thoracic cavity in dogs and cats. It outlines different surgical approaches for thoracotomy including intercostal, rib resection, median sternotomy, and transsternal thoracotomies. Special considerations for thoracotomy procedures are noted such as providing oxygen and ventilation. Intercostal thoracotomy is described as the standard approach. Placement of a thoracostomy tube is explained. Various structures that can be accessed from the left and right sides via thoracotomy are listed. Complications are uncommon if the incision is closed airtight.

2. Thoracotomy
 surgical incision of the chest wall.

3. SURGICAL ANATOMY
The thoracic cavity of dogs n cats are compressed laterally so
greatest dimension is DV.

4. Intercostalis
externus
Rectus
abdominis
Obliquus externus
abdominis
Rectus
thoracis
Scalenus
dorsalis
Serratus
ventralis,
Serratus dorsalis cranialis
Obliquus internus
abdominis
Serratus dorsalis
caudalisLongissimus
thoracis

6. Levator costae
Intercostalis internus
Intercostalis
externus

14. SURGICAL APPROACHES
Intercostal Thoracotomy
Rib Resection Thoracotomy
Median Sternotomy
Transsternal Thoracotomy

15. Special Considerations:
 In animals with respiratory dysfunction, oxygen may be
administered.
 All animals with open chest cavities require intermittent
positive pressure ventilation (including those with
diaphragmatic hernias).
 High ventilatory pressures should be avoided in patients
with chronically collapsed lung lobes, pneumonia.
 Thoracotomy procedures often cause substantial pain, and
postoperative analgesic therapy is indicated.

16. Intercostal Thoracotomy
 Standard approach
 Excellent access to immediate structures
 Complications – uncommon, if airtight closure
 3rd to 10th ICS
 Lateral radiograph

17. Finochietto retractors

18. THORACIC STRUCTURE LEFT RIGHT
Heart and Pericardium
PDA, Persistent Rt Aortic Arch
Pulmonic Valve
4,5
4 (5)
4
4,5
Lungs
Cranial lobe
Intermediate lobe
Caudal lobe
4-6
(4) 5
5 (6)
4-6
(4) 5
5
5 (6)
Esophagus
Cranial
Caudal 7-9
3,4
7-9
Caudal Venacava (6-7) 7-9
Thoracic Duct
Dog
Cat
(8-10)
8-10
8-10
(8-10)

19. Thoracostomy Tube Placement
Make an incision over
the dorsal third of the intercostal
space.
Tunnel the tube with
trocar - tipped stylet cranioventrally

20. Tilt the tube perpendicular
to the thoracic wall, Hit the
end of the tube
to pop it through the
intercostal space
and pleura

21. advance the tube
cranially into the thorax

22. Clamp the tube once the
stylet is partially retracted
Adjust the tube position so
that the tip is at the level of the second
intercostal space before securing it in
place.

25. Lateral Rib Resection Thoracotomy
 A wider exposure of the chest (eg : removal of large
masses)
 Increased time & less secure closure
 Infrequently used in small animals

28. Median Sternotomy
 Entire thorax view
 Spontaneous pneumothorax /pericardiectomy/
exploratory thoracotomy
 Access to dorsal thoracic cavity is limited
 Oscillating bone saw/ chisel/ osteotome

33. Transsternal Thoracotomy
 IC thoracotomy extended through sternum and
continued to other side’s ICS
 Extensive exposure of specific region
 Infrequently used
 7th ICS - DH

35. 1. PECTUS EXCAVATUM
 Inward concave deformation of caudal sternum and
costal cartilages
 Retarded growth, dyspnoea, exercise intolerance,
vomiting, cyanosis
 Sx indicated if Cardio pulmonary effect is v severe
 Multiple chondrotomy, excision of malformed costal
cartilages, sternum struts, external splinting

37. 2. RIB DEFORMITIES
 Missing ribs
 Fused ribs
 Multiple ribs
 Malformed Ribs
 Sx –if restricted ventilation & paradoxical respiration

38. 3. METABOLIC BONE DISEASES
 Primary parathyroidism
 Hypervitaminosis
 Cartilage exostosis
 Tx: According to underlying cause

39. 4. INFECTION
 Bite, lacerations, FB  Infection. Check pyothorax
before tx.
 Tx: Drainage, Debridement
 Osteomyelitis  Partial sternectomy
 FB Fistulous tract  Contrast fistulogram  excision

40. 5. TRAUMA
 Internal injury!
 Tx: Small wounds: standard
 Open wound upto pleura  seal with petroleum based
gauze
 Open chest wound  pleural evacuation &
stabilisation

41.  IC muscle rupture -> closure like thoracotomy
 IC vessel rupture
 Simple non displaced rib # - rest & chest bandage
 Unstable rib # : Internal fixation
 Flail Chest : stabilisation, circumcostal suture, splint

45. 6. NEOPLASIA
 Skin / sc benign , lipomas
 Osteosarcoma, chondrosarcoma, fibro sarcoma,
haemangiosarcoma
 Internal thoracic wall –considered malignant
 Neoplasms of rib – Primary malignant
 Dx- Radiograph – osteolysis, extra thoracic soft tissue
masses, mineralization, biopsy
 Tx: Resection. Prognosis poor for osteosarcoma