Physiotherapy and pulmonary surgery

1. PULMONAR
Y SURGERY
Dr. Tarpan Shah. MPT (CPD&ICU care),
(DNHE)
Vice-Principal &Asst.Prof
Shree Swaminarayan Physiotherapy college

2. • Lung surgery is the surgery to repair or
remove lung tissue
• Biopsy of an unknown growth
• Lobectomy
• Lung transplant
• Pneumonectomy
• Surgery to prevent the build up or return of
fluid to the chest (pleurodesis)
Dr.Tarpan Shah 2

3. • Surgery to remove an infection or blood in the
chest cavity(empyema)
Dr.Tarpan Shah 3

4. • General anaesthesia given
• Pt will be be asleep and not felt any pain
• Two common ways thoracotomy and video
assisted thoracoscopic surgery(VATS)
• Thoracotomy means open surgery
• Risks in surgey---
• Allergic reactions to medicines
• Breathing problems
Dr.Tarpan Shah 4

5. • Bleeding
• Blood clots
• Infection
• Failure of lung to expand
• Injury to the lungs
• Pain
Dr.Tarpan Shah 5

6. • Prognosis---
• Depends on
• Type of problem being treated
• How much of the lung is removed
• Overall health before surgery
Dr.Tarpan Shah 6

7. INDICATIONS FOR SURGERY
• Commonest is bronchial carcinoma
1.Malignancy- primary bronchial carcinoma,
isolated secondaries arising from kidney or
large intestine
2.Inflammatory- lung resection is required
occasionally for lung abscess, tuberculosis ,
bronchiectasis
Dr.Tarpan Shah 7

8. 3.Trauma- stab wounds, gun shot wounds
4.Degerative- large bullae in selected patients
where there is compression of normal lung
5.Congenital- lobar emphysema
Dr.Tarpan Shah 8

9. INCISIONS
A)Lateral incision
1) Posterolateral incision:- this follow the vertebral
border of scapula and line of rib 5th 6th 7th 8th to
anterior angle of costal margin
Muscles cut are:- trapezius, LD, serratus anterior,
rhomboids, intercostals, erector spinae
This incision is used for the lung operation
Dr.Tarpan Shah 9

10. Dr.Tarpan Shah 10

11. 2) Antero-lateral incision:- this start at middle of
the anterior chest up to the posterior axillary
fold.
Muscles cut are:- pectoralis major and minor,
serratus anterior, intercostals.
This incision is used for mitral valvotomy and
pleurectomy.
Dr.Tarpan Shah 11

12. B) Anterior incision
1) Transverse:- this passes across the one side of
the 4th IC space to the other.
Muscles cut are:- pectoralis major,
intercostals.
2) Vertical incision:- splitting of the sternum
down the middle
NO MUSCLE CUT
This incision is used for open heart surgery.
Dr.Tarpan Shah 12

13. Types of operaTion
1) Pneumonectomy
2) lobectomy
3) Segmental or wedge resection
Dr.Tarpan Shah 13

14. Dr.Tarpan Shah 14

15. Dr.Tarpan Shah 15

16. CompliCaTion of
surgery
1) Respiratory
- infection of the lung
- consolidation / collapsed
- pneumothorax
- broncho-pleural fistula
Dr.Tarpan Shah 16

17. BronCHopleural
fisTula
• It implies breakdown of the bronchial stump
and it occcurs around the 10 th postoperative
day ,if small it may not be noticed untill much
later
• It is recognised by dyspnea ,an irritating cough
and possible expectoration of dark fluid
• The patient should be sat up or turned on to
the operated side to prevent spill over of
infected fluid in to the remaining lung
Dr.Tarpan Shah 17

18. Dr.Tarpan Shah 18

19. 2) Circulatory:-
 DVT
 Cardiac arrhythmia
 Haemorrhage
3) Wound:-
 Infection
 Failure to heal
 Adherent scar
4) Joint stiffness:-
 Sh joint
 Thoracic spine
 Costo-vertebral joints
Dr.Tarpan Shah 19

20. 5) Muscle weakness:-
 LD
 Serratus anterior
 leg muscle if unexercised
 other divided muscles
6) Postural deformity:-
 forward or sideward bending
Dr.Tarpan Shah 20

21. pneumoneCTomy
• Removal of entire lung
• Radical Pneumonectomy along with that of entire
lung mediastinal gland is also removed.
Complication:-
• Damage to phrenic nerve
• Damage to recurrent laryngeal nerve
Indication:- Carcinoma, bronchiectasis,
tuberculosis
incision is posterolateral incision Dr.Tarpan Shah 21

22. preoperaTive
pHysioTHerapy
• Gain the confidence of patient
• Clear the lung field
• Breathing exercise
• Postural awareness
• Teach arm, trunk, leg exercise
• Splinting of incision during coughing
• Bed mobility
Dr.Tarpan Shah 22

23. Postoperative chest physiotherapy
• Clear the lung field
• Reexpansion of the lung
• Prevent circulatory complication
• Prevent wound complication
• Regain the arm and trunk movement
• Maintain the good posture
• Conditioning exercise
Dr.Tarpan Shah 23

24. Key points
• Breathing exercises should be started on the
day of surgery if possible.
• ACBT to remove the secretion and restore the
lung volumes and capacities
• Adequate wound support for huffing and
coughing should be taught.
Dr.Tarpan Shah 24

25. • Early mobilization
progressing to stair
Climbing on third day
postoperatively
• Exercise using a
bicycle ergometer
Dr.Tarpan Shah 25

26. • Tracheal deviation- result into ineffective
cough production
• Huffing rather than coughing is emphasized
because of less chances of increase in
intrathoracic pressure
• If suctioning is required than take care of
stump.
• Breathing control with stair climbing may
increase exercise tolerance.
Dr.Tarpan Shah 26

27. Splinting
Dr.Tarpan Shah 27

28. lobectomy
• Indication
• Bronchiectasis
• Tuberculosis
• Lung abscess
• Carcinoma
Dr.Tarpan Shah 28

29. Day of operation
• Half lying
• Breathing exercise to expand the whole lung
• Vibration over unoperated side
• Huffing with splinting
• Foot or ankle exercise
Dr.Tarpan Shah 29

30. Day – 1 ( 3- 4 session)
• Analgesia to reduce the pain so pt will
cooperate in treatment
• Nebulizer therapy or humidification therapy
• Breathing exercise with inspiratory hold
• Side lying on unoperated side
• Chest expansion exercise on remaining side
• Postural drainage
Dr.Tarpan Shah 30

31. • Exercise of arm
• Assisted arm elevation
• Assisted arm movement in functional pattern
• Neck exercise
Dr.Tarpan Shah 31

32. • Exercise for leg
• Foot and ankle exercise
• Quadriceps contraction
• Hip and knee bending exercise
Start ambulation
Dr.Tarpan Shah 32

33. Day-2
• Self supported splinting
• Chest expansion exercise
• Breathing exercise
• Unoperated side positioning
• Arm as well as leg exercise
• Start trunk exercise
• Discourage the pt for crossleg sitting it will occlude
popliteal artery and can result into DVT
Dr.Tarpan Shah 33

34. Day 3- 4
• Arm and trunk exercise should continue
• Increase the walking distance
• Stair climbing
• Group therapy
• Aerobic exercise
Dr.Tarpan Shah 34

35. • Discharge at 10-12 days of post op
• Home exercise programme
• Aerobic exercise ( hyper Chest expansion
exercise
• Ventilatory muscle training
Dr.Tarpan Shah 35

36. • Pain. Extrapleural bupivicaine infusion is an
increasingly popular method of pain control
following a thoracotomy.
• Bronchial secretions. The appropriate timing
and selection of minitracheotomy can help reduce
the incidence of sputum retention.
• Pneumonia is a serious complication with a
high mortality rate.
Dr.Tarpan Shah 36

37. • Atrial fibrillation is common with extensive
resection in the elderly. Onset is usually 2-5
days postoperatively.
• Wound infection
• Haemorrhage. Significant bleeding, usually
involving the bronchial arteries, occurs in 1-2%
of patients. It is more likely after a
pneumonectomy.
Dr.Tarpan Shah 37

38. SEGMENTAL RESECTION
• A bronchopulmonary segment is removed
with its segmental artery and bronchus
• Used for tuberculosis
Dr.Tarpan Shah 38

39. WEDGE RESECTION
• This non anatomical resection is used for
diagnosis in open lung biopsy and treatment
of well localised peripheral carcinomas in
patients with redused lung function
Dr.Tarpan Shah 39

40. ThORACOpLASTy
• This operation is performed to produce the
permanent collapse of a lung.
• This operation is performed in TB and
emphysema.
– Complication: deformity
paradoxical breathing
Dr.Tarpan Shah 40

41. pLEuRAL SuRGERy
1) Pleurectomy: is removal of parietal layer of
pleura e.g. pneumothorax
-Visceral layer pleura stick with the chest wall
2) Pleurodesis: insertion of powder into the
pleural cavity, which act as a irritants.
- Position the pt in 10 min for each position
- Expansion breathing exercise is performed in
each position.
Dr.Tarpan Shah 41

42. • 3) Decortication :
- stripping of the two layer of pleura that
have become adherent with eachother.
• E.g. empyema
Dr.Tarpan Shah 42

43. Dr.Tarpan Shah 43