GSW TO RIGHT CHEST. IT GETS WORSE

[KMATTOX at aol.com]

In a message dated 9/4/2007 3:43:39 P.M. Central Daylight Time,  
mgreeds at reeds.uk.com writes:

1)   a resection and primary anastomosis (with numerous drains - in  case
of a subsequent anastomotic leak/breakdown);

2)   bringing out the "leak" through the chest as a T-tube;  or,

3)     oesophagostomy



I would be keen  to hear others' views on this list regarding which procedure
they would  perform (I am sure that there are people who sit STRONGLY in each
of the  respective camps!)




It depends on the amount of contamination, and I could support  each.   If I 
did an esophagostomy (cervical), I would ADD a draining  gastrostomy and a 
feeding jejunostomy.     
 
One other BIG point.   As I entered the chest, I would prepare a  4ICS 
intercostal muscle flap, to WRAP the esophageal repair with upon completion  of the 
procedure.   At this juncture, however, this possibliity is  probably 
"trashed" by the first operation, with vascular compromise of the  potential muscle 
pedicle.   I have always prepared such a muscle flap  any time I go into the 
chest with a potential esophageal injury. 
 
k mattox



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