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Introducción. La perforación esofágica se define como la ruptura transmural del esófago. Existen diferentes causas, como neoplásicas, traumáticas, lesión por cuerpos extraños, ingesta de cáusticos, iatrogénicas o espontáneas, denominadas Síndrome de Boerhaave. La tasa de mortalidad es alta y oscila entre 40-60 % con manejo óptimo, hasta el 100 % sin tratamiento. Caso clínico. Se presenta el caso de una paciente de 70 años, que ingresó por 5 días de sensación de globus faríngeo, disnea y dolor torácico. Se realizó una tomografía computarizada de tórax donde se visualizó un derrame pleural derecho, que fue manejado con toracostomía cerrada. Posteriormente, se visualizó la salida de material alimentario por la sonda de toracostomía, por lo que se hizo una nueva tomografía de tórax y abdomen encontrando una fístula esofagopleural. En una esofagografía por tomografía donde se vio extravasación del medio de contraste en la región infracarinal hacia espacio pleural derecho. Resultados. Fue llevada a toracotomía, encontrando empiema y atrapamiento del lóbulo inferior derecho por abundante fibrina, pus y restos alimentarios, secundario a perforación esofágica del tercio medio. Se practicó esofagorrafia, pleurectomía y decorticación. Se continuó manejo endoscópico con sistema de vacío de forma seriada. Conclusiones. Las perforaciones esofágicas son un desafío para los cirujanos, tanto en el enfoque diagnóstico inicial, como en el tratamiento. Conocer los abordajes endoscópico, quirúrgico y mixto ayuda a ampliar las opciones de manejo en estos pacientes. El tratamiento oportuno, las indicaciones no operatorias y las nuevas medidas endoscópicas para el manejo impactan en la mortalidad.

El uso de cirugía toracoscópica videoasistida (VATS), se ha extendido en los últimos años, de un modo impensable, desarrollando y perfeccionando un arsenal de instrumentos que son utilizados para todo tipo de intervenciones endoscópicas, permitiendo la realización de intervenciones en cavidad torácica, esta investigación se centra en determinar la eficacia y seguridad de la insuflación de dióxido de carbono intrapleural en la cirugía toracoscópica video asistida aplicada en patologías torácicas, pleuropulmonares y mediastínicas, con el fìn de disminuir la morbimortalidad en pacientes. El estudio es de tipo prospectivo, de carácter longitudinal y descriptivo, con una muestra de 200 pacientes, período enero 2014 – junio 2017, principales desenlaces: tiempo quirúrgico, drenaje postoperatorio, estancia hospitalaria, ventilación mecánica, complicaciones. Los resultados obtenidos fueron: Genero Femenino 51%, Edad promedio 52, VATS 74,5%, Toracotomía 25,5%, tiempo quirúrgico 120min, Sangrado transoperatorio 113ml, Estancia hospitalaria 3d, Ventilación mecánica 59,10%, Complicaciones postoperatorias atelectasia 36,9%, neumonía 18,1%, enfisema 7,4%. De acuerdo a los resultados obtenidos se concluye que el abordaje por VATS es una técnica rápida, segura, de invasión mínima y altamente efectiva en el diagnóstico y tratamiento de pacientes con patologías pleuropulmonares o mediastínicas.

Introduction: Aortic stenosis is the most common valvular heart disease requiring surgical treatment. Minimally invasive surgical techniques have emerged as alternatives to traditional median sternotomy. Objective: To analyze the possible risk factors associated with major bleeding in patients undergoing aortic valve replacement via right anterior mini-thoracotomy and to share the results found in our center. Materials and methods: A retrospective, observational, longitudinal study was conducted in patients undergoing right anterior mini-thoracotomy from July 2015 to December 2022. Demographic and clinical data, as well as relevant surgical and echocardiographic variables, were collected. Results: The mean age of the study population had a mean age of 58 years, with a predominance of men under 65 years of age. Only three patients experienced major bleeding 4.47%. Advanced age and extracorporeal circulation time (minutes) were associated with bleeding. No significant differences were found in other variables analyzed. Conclusions: The study results indicate a low rate of postoperative bleeding in minimally invasive surgery. Advanced age and prolonged extracorporeal circulation time were identified as significant risk factors for major bleeding. However, further studies with a larger sample size are needed to better understand these factors and the safety of minimally invasive surgery. [ABSTRACT FROM AUTHOR]

Patient with spondylodiscitis who presented kyphosis deformity with neurological compromise at the upper thoracic level, who was treated with a new right infraclavicular anterior thoracic approach, as a new alternative surgical technique. 72-year-old male with kyphosis deformity secondary to T2-T3 ASIA «C» spondylodiscitis, treated with C5 to T6 posterior cervicothoracic instrumentation and right infraclavicular transthoracic anterior approach utilizing an expandable cylinder. Within the literature review carried out in the search engines, no similar techniques to the one described in this article were found. Given the complexity of the surgical approach, this new technique is described as a new way for accessing the upper thoracic spine, demonstrating that the right infraclavicular anterior thoracic approach is a new alternative to access the upper thoracic spine from T1 to T4. [ABSTRACT FROM AUTHOR]

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O autor faz um estudo geral do problema dc câncer do pulmão, em face dos atuais meios que dispomos. Friza da necessidade do exame sistemático e periódico do grupo etário acima de 40 anos e principalmente entre o sexo masculino e fumante. Chama a atenção para a importância da divulgação dos conhecimentos entre a população leiga e também entre os médicos, no sentido de se diagnosticar o câncer do pulmão no seu periodo assintomático. Termina concluindo: a) — só a cirurgia é capaz de curar o câncer do pulmão; b) — procurar levar o paciente à mesa de operações com o diagnóstico anátomo-patológico; c) — evitar perda de tempo, insistindo no diagnóstico pré-operatório; d) — A toracotomia é além de diagnóstica, curativa; e) — A toracotomia hoje é quasi tão benigna quanto a laparotomia.

Objective: To describe the profile of patients treated in the "Red Wave", in the period of 2018-2019. Methods: It is a quantitative, cross-sectional, retrospective, descriptive and documentary research. Held at the first-aid post João XXIII Hospital, in Belo Horizonte. The universe of this study was 83 electronic medical records of patients who entered the "Red Wave" protocol. Simple frequency distributions, measures of central tendency (mean and median) and variability (standard deviation) have been performed. Results: Male, aged between 1 and 95 years old, being an average at 33,4 years old. The most frequent trauma mechanism was blunt, the means of transport was an ambulance from the Mobile Emergency Service, the causes of the trauma were an automobile accident, followed by trauma by a firearm projectile. From the performed surgeries, the most frequent ones were laparotomy, thoracotomy and craniectomy. Among the outcome, death was the most common one among patients. Conclusion: Patients arrive very seriously and death was the main outcome. Studies that allow comparative data analysis and standardization of the calculation of survival probability are suggested. It is recommended to update the red wave protocol, including other surgeries that are already performed and new inclusion criteria for patients. [ABSTRACT FROM AUTHOR]

Introducción: El secuestro pulmonar es una malformación del tracto respiratorio inferior, que consiste en una masa no funcional de tejido pulmonar sin comunicación con el árbol traqueobronquial y su irrigación sanguínea proviene de una o más arterias sistémicas aberrantes. Objetivo: analizar los resultados de los pacientes pediátricos con secuestro pulmonar tratados con resección quirúrgica (toracotomía, videotoracoscopia) o embolización endovascular. Métodos: estudio descriptivo, observacional, retrospectivo, de corte transversal, realizado en un hospital pediátrico de tercer nivel en Ecuador, desde enero de 2017 a diciembre de 2022. Los datos fueron obtenidos de las historias clínicas revisadas. Resultados: Se incluyeron 9 pacientes, menores de 18 años con el diagnóstico de secuestro pulmonar, 6 femenino y 3 masculino, 5 fueron tratados con cirugía, 4(44%) por toracotomía y 1(11%) por videotoracoscopia, 4 (44%) con embolización endovascular, la edad promedio de los pacientes sometidos a cirugía fue de 41,36 (rango: 0,1-144 meses), y de los que recibieron embolización fue de 12,9 meses (rango: 0,6-41 meses). un paciente falleció 6 días posterior a la resección quirúrgica del secuestro pulmonar por toracotomía debido a hipertensión pulmonar por su cardiopatía de base y 1 paciente tratado con embolización presento disminución del pulso pedio el cual se resolvió a las 24 horas de iniciada la estreptoquinasa. Conclusión: Hasta donde hemos investigado no hemos encontrado otra publicación en nuestro país donde se comparen dos métodos terapéuticos para el tratamiento del secuestro pulmonar, en este estudio tanto la cirugía como la embolización fueron procedimientos seguros, sin embargo, no se encontró diferencias significativas entre ambas opciones terapéuticas, es necesario estudios con mayor población y con características prospectivas en los pacientes tratados por embolización endovascular.

El doble arco aórtico persistente es una patología caracterizada por anomalías embrionarias en la vascularización, que pueden afectar de manera indirecta a otros sistemas, como el digestivo y el respiratorio. El objetivo de este documento es reportar un caso de doble arco aórtico, persistente en un cachorro Bull terrier, de seis meses de edad. El paciente ingresó a consulta por motivo de regurgitaciones frecuentes y pérdida ponderal. En el estudio radiográfico, se evidenció dilatación esofágica craneal a la base del corazón y en la toracotomía, se confirmó un doble arco aórtico persistente. Se realizó manejo nutricional y posteriormente, corrección quirúrgica de la anomalía vascular. Este es el primer caso de una anomalía de este tipo en Colombia. Se concluye, que un manejo quirúrgico enfocado a liberar el anillo estenosante y a recuperar la función esofágica, son la base terapéutica de este tipo de alteraciones.

Vertical axillary thoracotomy is a surgical procedure that allows multiple techniques to be performed for the diagnosis and treatment of chest diseases, an area that involves special anesthetic considerations. The present study aims to expose determinants for the anesthetic management of patients operated on for axillary thoracotomies. A bibliographic review was carried out by searching databases (Medline / Pubmed and Hinari), including the terms: vertical axillary thoracotomy, anesthetic management and thoracic surgery. The determinants identified within anesthetic management during vertical axillary thoracotomy were preoperative evaluation, monitoring, airway management, ventilation strategy, anesthetic treatment, and immediate postoperative analgesia. According to the needs and conditions of the team, it was determined to establish as a priority the defense of the optimal moment of muscle relaxation. Hemodynamic control of the patient, pulmonary isolation, muscle relaxation for the surgical approach, pulmonary ventilation, and perioperative analgesia continue to be the cornerstone of anesthetic management in vertical axillary thoracotomy today.

Copyright of Acta Veterinaria Brasilica is the property of Acta Veterinaria Brasilica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Pulmonary bullae are thin-walled cavitary lesions within the subpleural parenchyma. They are a result of the destruction, dilatation and coalescence of bordering alveoli and their rupture is the most common cause of pneumothorax in dogs. Radiographic and CT imaging are excellent tools for identifying and quantifying pneumothorax. Surgical treatment is considered standard for treatment of pneumothorax consequential to pulmonary bullae. The aim of this report was to describe a case of pneumothorax secondary to pulmonary bullae in a dog. Case: A 5-year-old male crossbreed dog, weighing 11.5 kg, was presented to the Uberaba’s Veterinary Hospital due to becoming easily tired in the previous 3 weeks, and its worsening in the last 2 days by presenting panting. The dog’s guardian did not witness any traumas, but informed that the animal resided with other 14 dogs and also that it frequently collided the thorax against the door when it came down from the bed. Physical examination showed diaphragmatic breathing, inspiratory dyspnea and stridor lung sound. Thoracocentesis revealed presence of air in the pleural cavity and pneumothorax. Radiographic images confirmed this condition. The dog stayed in the hospital and chest drains were placed. Since the amount of sucked air did not reduce with time and due to the emergence of subcutaneous emphysema, the dog went through exploratory thoracotomy that revealed impairment of the right caudal lung lobe, proceeding to lobectomy. The dog stayed in the hospital with chest drains until the contents of the suctions reduced significantly. With the removal of the drains, the dog was sent home and had a full recovery. Histopathology of the impaired lung revealed pulmonary bullae. Discussion: The dog from this report presented clinical signs consistent with pneumothorax, such as dyspnea, diaphragmatic breathing and exercise intolerance. Radiography of the chest region revealed images consistent with this condition, as it is an excellent tool for identifying it. This dog’s guardian was unable to confirm if there was occurrence of trauma due to the large number of cohabitants. In dogs, spontaneous pneumothorax commonly results from the rupture of pulmonary bullae, and these bullae may result from trauma, infectious diseases, thrombosis, obstructive, neoplastic, congenital or idiopathic conditions. Except from trauma, there were no evidence to support any of the other causes of pulmonary bullae in this case. Traumatic injuries are very common in veterinary medicine, and blunt thoracic traumas with consequential pneumothorax are especially common. The emerging of subcutaneous emphysema, as happened with this dog, is frequently associated with pneumomediastine, and rarely has pathophysiologic impairments. The patient stayed in the hospital for support therapy and thoracocentesis, corroborating with literature; but since there was no improvement, it went through exploratory lobectomy, which revealed impairment of the right caudal lung lobe, proceeding to its exeresis. Surgical intervention is standard procedure in these cases. Histopathology of the impaired lung suggested the presence of pulmonary bullae. In literature, histopathological definitions for this condition are inconsistent, but usually locate the bullae within the pulmonary parenchyma, having walls less than 1 mm thick. Through radiology, unlike with cysts, identifying pulmonary bullae is challenging. In conclusion, this report showed that pulmonary bullae should be considered as a differential diagnose in patients showing pneumothorax considering it is hard to identify through imaging, and that it is important to adopt early therapy and surgical intervention for better outcomes. [ABSTRACT FROM AUTHOR]

Background: Thoracic Trauma (TT) is the cause of approximately a quarter of trauma deaths. The patients who undergo Thoracic Trauma Surgery (TTS) present a wide spectrum of characteristics and prognosis. Aim: To describe clinical characteristics, indications, temporality, morbidity, mortality and mortality associated variables in TTS patients. Materials and Method: Observational study of TT hospitalized patients, period January-1981 to December-2019. A review of operation notes and database was done. A logistic regression for mortality associated variables was made. To compare classification, type of TT and its temporal distribution, SPSS25® with chi-square test was used, considering significant p < 0.05. Results: A total of 808 (18.2%) of 4.448 TT patients required TTS, 767 (94.9%) were men with average age: 31.5 ± 13.8. The trauma was penetrating trauma due to a stab in most cases, 164 (20.3%) were polytraumatized. The surgery was urgent in 474 (58.7%), early in 41 (5.0%) and delayed in 293 (36.3%) cases. The global mortality was 6.7% and was significantly higher in the blunt TT, polytrauma, urgent and early surgery patients. Mortality in urgent TTS was 9.7%, early 4.9% and 2.0% in delayed (p < 0.001). Independent variables associated with mortality were observed. Conclusions: In our series, TTS were performed mainly in young men with penetrating TT. The group was heterogeneous regarding surgical indications, findings and intrathoracic or associated injuries. Multiple variables showed to influence significantly on mortality in patients who underwent TTS. [ABSTRACT FROM AUTHOR]

Objective: During the last decades, cardiac surgery has revolutionized, there is a growing interest in minimizing the physical aggression of surgical procedures, seeking a quick recovery, minimally invasive approaches have been a trend in recent years, with safety and efficacy equivalent to traditional techniques sternotomy. The objective of this study is to compare clinical results between pediatric patients with congenital heart disease undergoing minimally invasive surgery versus standard sternotomy. Methods: Case-control study, nested in a retrospective cohort. All pediatric patients over 10 kg in weight were included, between 2014 and 2019 who underwent surgical correction of simple congenital heart disease, in a cardiovascular center in Medellin. A case was defined as one that underwent a minimally invasive approach (MICS) and control patients who were approached in a conventional manner (CONV). 122 patients were admitted, with a mean age (MICS: 6, 4-12 vs. CONV: 5, 2-8 years). No differences were found in the baseline characteristics of both groups. No statistically significant difference was documented in infusion times (MICS: 67 min [50-90] vs. CONV: 53 min [42-90]; p = 0.54), nor differences in complications (MICS: 7.4 vs. CONV: 8.8%; p = 0.77). MICS patients had lactate on admission and a shorter ICU stay than controls. Conclusion: The MICS approach turns out to be a novel, less invasive, safe and efficient technique compared to the conventional surgical approach for the repair of simple congenital heart disease in pediatric patients. [ABSTRACT FROM AUTHOR]

Giant esophageal leiomyomas are rare neoplasms with an imprecise clinical course; most originate from the middle and lower portion of the organ. Imaging and endoscopic tests are used to identify the proper diagnosis and treatment. The purpose of this work, based on a new case, is to share and disseminate a new report of giant esophageal leiomyoma. The patient was admitted for dysphagia. Diagnostic tests included radiography of the esophagus, stomach, and duodenum, upper digestive endoscopy, computed tomography, and MRI. The patient underwent surgery by right thoracotomy, enucleation of a 10x6x5cm tumor was performed, and the integrity of the mucosa was verified. There was no evidence of malignancy in the histopathological study. He was discharged eight days after surgery. Thoracotomy with enucleation of the esophageal tumor is an effective procedure to treat patients with giant leiomyoma.

Objective: This study aimed to investigate the impact of post-thoracotomy analgesia with dexmedetomidine and morphine on immunocytes. Methods: A total of 118 patients with post-thoracotomy Patient-Controlled Intravenous Analgesia (PCIA) in our hospital from March 2016 to July 2018 were randomly selected and divided into the Composite (COM) Group (57 patients administered with dexmedetomidine [1.0 μg.kg-1 body weight] and morphine [0.48 mg.kg-1 body weight]) and the Morphine (MOR) group (61 patients administered with morphine [0.48 mg.kg-1]). The values of lymphocyte subsets (CD3+, CD4+, and CD8+) and Natural Killer cells in the peripheral blood of these two groups were detected by FACSCalibur flow cytometry at different time points (before anesthesia induction [T0], immediately after tracheal extubation [T1], 12 hours after surgery [T2], 24 hours after surgery [T3], 48 hours after surgery [T4], 72 hours after surgery [T5], and 7 days after surgery [T6]). The doses of morphine at T3 to T5 and the adverse reactions between the two groups were also recorded and compared. Results: The CD3+ level and the CD4+/CD8+ ratio at T2 to T5 and the CD4+ level and NK cells at T3 to T5 were significantly higher in the COM Group than in the MOR Group (p< 0.05). The postoperative morphine dose and the incidence of postoperative itching, nausea, and vomiting were significantly lower in the COM Group than in the MOR Group (p< 0.05). Conclusions: Dexmedetomidine combined with morphine for post-thoracotomy PCIA can improve the function of immunocytes, reduce morphine consumption, and reduce the adverse reactions during analgesia induction. Resumo: Objetivo: Estudar o impacto em linfócitos causado pelo uso da dexmedetomidina associada à morfina para analgesia pós-toracotomia. Método: Um total de 118 pacientes utilizando Analgesia Intravenosa Controlada pelo Paciente (AICP) pós-toracotomia em nosso hospital de Março de 2016 a Julho de 2018 foram selecionados aleatoriamente e divididos em dois grupos: o Grupo Gombinado [COM, 57 pacientes que receberam dexmedetomidina (1,0 μg.kg-1 de peso corpóreo) associada à morfina (0,48 mg.kg-1 de peso corpóreo)] e o Grupo Morfina [MOR, 61 pacientes, que receberam somente morfina (0,48 mg.kg-1)]. Os valores dos subconjuntos de linfócitos (CD3+, CD4+ e CD8+) e das células NK no sangue periférico desses dois grupos foram medidos por citometria de fluxo FACSCalibur em diferentes momentos do estudo [antes da indução anestésica (T0), imediatamente após extubação traqueal (T1), 12 horas após a cirurgia (T2), 24 horas após a cirurgia (T3), 48 horas após a cirurgia (T4), 72 horas após a cirurgia (T5) e 7 dias após a cirurgia (T6)]. As doses de morfina do momento T3 ao T5 e as reações adversas entre os dois grupos também foram registradas e comparadas. Resultados: O nível de CD3+ e a razão CD4+/CD8+ de T2 a T5, e o nível de CD4+ e as células NK de T3 a T5 do Grupo COM foram significantemente maiores (p < 0,05), quando comparados ao Grupo MOR. A dose de morfina no pós-operatório e a incidência de prurido, náusea e vômito no pós-operatório foram significantemente menores no grupo MOR (p < 0,05). Conclusões: Dexmedetomidina combinada com morfina para AICP no período pós-toracotomia pode melhorar a função dos linfócitos, reduzir o consumo de morfina e diminuir reações adversas durante a analgesia.

Mediante el presente estudio retrospectivo se revisaron 466 historias clínicas de pacientes atendidos por el servicio de urgencias quirúrgicas del Hospital San Juan de Dios de Bogotá, durante el periodo entre el 1° de marzo de 1981 y el 28 de febrero de 1986. Los pacientes en la serie estudiada fueron en su mayoría de sexo masculino (92%); se estableció una relación hombre/mujer de 11:1. El grupo de edad más afectado estuvo entre los 10 y 29 años (58%). La mayoría de los pacientes sufrió trauma penetrante (96,3%); 17 pacientes (3,7%) sufrieron trauma cerrado. El hemidiafragma más comprometido fue el izquierdo. Las manifestaciones clínicas más sobresalientes fueron: dolor abdominal, hipoventilación del hemitórax afectado, disnea, hemoneumotórax y defensa abdominal. Los métodos paraclínicos demostraron un bajo grado de especificidad diagnóstica. Las lesiones asociadas en su orden de frecuencia estuvieron localizadas en nivel del hígado, estómago, bazo, colon, intestino delgado, pulmón, páncreas, sistema vascular y óseo. El acceso quirúrgico en 413 casos se efectuó por laparotomía, en 37 por toracolaárotomía, y en los 13 restantes por toracotomía. La hernia diafragmática se presentó, en el 6%; y la mortalidad global fue del 10,5%.

En forma no infrecuente y debido a lesiones torácicas o toracoabdominales con armas cortopunzantes o armas de fuego, y también con ocasión de traumas cerrados, ocurren lesiones del diafragma que favorecen la aparición de hernias diafragmáticas. Estas lesiones no siempre son detectadas en forma inicial y pueden pasar inadvertidas, lo que favorece la aparición de hernias crónicas. Las hernias diafragmáticas condicionan un importante riesgo de morbimortalidad y requieren un tratamiento quirúrgico inmediato. Se presenta la experiencia institucional del Hospital General Universitario de La Samaritana en el tratamiento de las hernias diafragmáticas en los últimos 10 años, y se hace una revisión de la literatura.

El trauma cardíaco ha ocurrido desde hace muchos siglos, siendo considerado inicialmente mortal en todos los casos. Desde la primera cardiorrajia exitosa realizada por Rehn, se han logrado considerables avances en el tratamiento de las heridas del corazón y, simultáneamente, se ha visto un marcado incremento de ellas debido a accidentes automovilísticos y al aumento de las acciones civiles violentas; la gran mayoría de las lesiones cardíacas son producidas por arma defuego o por arma blanca; sin embargo, ocasionalmente se han reportado casos en que tales lesiones son causadas por embolismo de cuerpos extraños, especialmente catéteres endovenosos y proyectiles, pero han sido muy pocos los casos en que la lesión cardíaca sea causada por la migración de un cuerpo extraño hasta el corazón, y sólo encontramos un caso reportado en que dicho cuerpo extraño produjo taponamiento cardíaco. Se presenta el caso de un paciente quien sufrió taponamiento ocasionado por lesión causada por una aguja de coser. Se hace una revisión de la literatura sobre el tema.

BACKGROUND: Most foreign body ingestions occur in older infants and preschoolers. Almost all of them are asymptomatic. The most frequently ingested objects are: coins and button batteries that can generate serious sequelae. Ten to 20% of swallowed objects require removal by endoscopy and less than 1% by surgery. The severity of the lesions and complications are closely related to the time of exposure to the foreign body. CLINICAL CASE: Two-year-old female patient with a history of nausea seven months earlier. The parents remembered having seen her playing with a battery, but without evidence that she had ingested it. Five months before coming for consultation, she started with regurgitation 1 to 2 times per week, malaise that evolved to regurgitation and postprandial emesis at all meals; in addition to sialorrhea and refusal to eat. No alterations were found in the physical examination. Radiography showed the existence of a circular metallic object, like a button battery. CT showed no apparent lesions in the surrounding tissues. Removal of the battery was attempted endoscopically but was unsuccessful. Removal was achieved by surgical intervention by right posterolateral posterolateral thoracotomy, with esophagotomy and esophagoplasty. CONCLUSIONS: Proper medical care of patients with suspected foreign body ingestion is critical to their prognosis. The evaluation should include a thorough clinical history and adequate physical examination. The diagnosis should always be suspected in patients with regurgitation, vomiting, refusal to feed, respiratory symptoms that do not subside despite treatment, especially in older infants and preschoolers. [ABSTRACT FROM AUTHOR]

Most of thoracotomies that are most frequently used in today's surgical practice were created in the operating rooms of the 20th century. In the search for different therapeutic options to treat cancerous and infectious conditions of the thoracic and mediastinal organs, the fathers of modern thoracic surgery created approaches that have stood the test of time and continue to be practiced, despite the enormous development of minimal access or video-assisted thoracic surgery. However, many surgeons are unaware of the events surrounding the birth of the main classical thoracotomies and, on the other hand, on more than a few occasions history has recognized as the fathers of some techniques those who do not really deserve that credit. In this third part of our review we continue to unravel the history of thoracic incisions, not all of which is well known. [ABSTRACT FROM AUTHOR]

Vertical axillary thoracotomy is a surgical procedure that allows multiple techniques to be performed for the diagnosis and treatment of chest diseases, an area that involves special anesthetic considerations. The present study aims to expose determinants for the anesthetic management of patients operated on for axillary thoracotomies. A bibliographic review was carried out by searching databases (Medline / Pubmed and Hinari), including the terms: vertical axillary thoracotomy, anesthetic management and thoracic surgery. The determinants identified within anesthetic management during vertical axillary thoracotomy were preoperative evaluation, monitoring, airway management, ventilation strategy, anesthetic treatment, and immediate postoperative analgesia. According to the needs and conditions of the team, it was determined to establish as a priority the defense of the optimal moment of muscle relaxation. Hemodynamic control of the patient, pulmonary isolation, muscle relaxation for the surgical approach, pulmonary ventilation, and perioperative analgesia continue to be the cornerstone of anesthetic management in vertical axillary thoracotomy today. [ABSTRACT FROM AUTHOR]

Copyright of Revista Habanera de Ciencias Médicas is the property of Universidad de Ciencias Medicas de La Habana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The 19th century saw more advances in thoracic surgery than in the more than 40 centuries since the writing of the Edwin Smith papyrus. In a period of less than a century, man approached the pericardial cavity not only to drain effusions, but to successfully suture wounds in the cardiac muscle. Moreover, the first thoracotomies were performed for the specific purpose of resecting lung segments and the sternum was completely opened for the first time, an incision that would eventually become the most widely used of all thoracotomies. Most thoracic surgeons know little about the true story behind many thoracotomies performed in the operating rooms of the 21st century. This second part of our review further unveils the unknown history of thoracic incisions. [ABSTRACT FROM AUTHOR]

Objective: To analyze and compare the survival of patients with pulmonary and pleural metastases in an initial thoracic surgery service. Methods: Retrospective longitudinal study of 19 patients with pulmonary and pleural metastases who underwent surgery between 2016 and 2020. Survival was analyzed using the Kaplan Meier curve. Results: Most were female, 84.2%, with a mean age of 64 years and 68.4% were non-smokers. Comorbidities were detected in 73.7% of patients, with arterial hypertension being the most prevalent. The most common primary tumors were breast and lung cancer. The most frequent approach (52.7%) was through videothoracoscopy. Chemotherapy treatment covered 84.2% of patients. Of the six patients who developed postoperative complications during hospitalization, 33.3% had pneumonia and 1 died. Overall survival at 30 months was 57.9%. Patients with pulmonary metastasis showed longer 30-month survival compared to those with pleural metastasis (75% vs. 50%; p=0.017). Regarding the primary tumor, patients with breast carcinoma had a 12-month survival of 85%, while among patients with colorectal cancer, the survival was 50%. Conclusion: According to our study, patients with pleural metastases have a worse prognosis when compared to patients with pulmonary metastases. The primary location of the tumor is associated with patient survival. [ABSTRACT FROM AUTHOR]

Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients. [ABSTRACT FROM AUTHOR]

Introducción. El avance de la cirugía torácica abierta a cirugía torácica asistida por vídeo por tres puertos, y sus posteriores efectos en la recuperación de los pacientes, conllevó al desarrollo de la técnica por un solo puerto, que ha mostrado beneficios en el postoperatorio. El objetivo de este estudio fue comparar los resultados postquirúrgicos de los pacientes sometidos a pleurectomía parietal y decorticación pulmonar toracoscópica asistida por video monopuerto y los obtenidos por toracotomía convencional, en una clínica de cuarto nivel, entre 2016 y 2019. Métodos. Estudio descriptivo, en el que se incluyeron 79 pacientes llevados a pleurectomía parietal y decorticación pulmonar por toracoscopia asistida por vídeo monopuerto y 25 pacientes operados por toracotomía convencional. Se evaluaron variables sociodemográficas, clínicas y postoperatorias. Se utilizaron las pruebas de Chi2 o de Fisher y las pruebas t de Student y Mann Whitney. Resultados. La mediana de edad fue menor en el grupo de pacientes operados por toracotomía convencional (28 años, RIC: 26–48, p=0,0005). No hubo diferencia en los tiempos quirúrgicos. Se encontró menor intensidad del dolor y disminución en los días con tubo de tórax, uso de antibióticos, días de UCI y días de estancia hospitalaria en el grupo de pacientes operados por toracoscopia asistida por vídeo monopuerto (p

Throughout the history of surgery many inaccuracies have surrounded the chapter related to the emergence of thoracic incisions. It will always be very difficult to determine the exact date and names of those who actually performed the first thoracotomies; obviously those who published or reported the first descriptions should be assumed as such, but the history has not always been well told. In some cases, only surnames are known; in some others, the inconsistency of time lapses opposes all logic. A thorough historical research has been carried out, which has made it possible to compile a brief account about the emergence of the most important thoracotomies, as well as to reveal some findings that are unknown to most thoracic surgeons. This is the first part of a brief account about the known facts, but also, it is especially about the unknown history of the thoracic incisions’ origin, which has overcome the test of time. [ABSTRACT FROM AUTHOR]

The case report of a 37 years patient that went to the Emergency Service of the Teaching General Hospital of Riobamba, in Ecuador, is described. He presented clinical and imaging signs that led to the diagnosis of an obstructive acute abdomen due to postraumatic chronic diaphragmatic hernia, reason why the treatment was surgical. Taking into account the patient's favorable clinical course he was discharged from the hospital 10 days after the surgery and received follow-up care during 3 months without presenting complications. [ABSTRACT FROM AUTHOR]

A male patient of 44 years old with a personal pathological history of arterial hypertension. He was admitted for extrahospital pneumonia of right base, it was indicated antibiotic treatment and the evolution was favorable. After 15 days he was re-admitted because he had worsened, it was performed a computerized axial tomography of high-resolution of the thorax that reported, at the level of the lung bases, several bilateral and peripheral hyperdense images that took on nodular shape, in intimate contact with the pleura, with central cavitation. A tumor etiology was considered and a thoracotomy was performed; samples of the pleura and lung were taken for biopsy. At the autopsy, necrotizing pneumonia was found in resolution phase and a bilateral pulmonary thromboembolism of thick branches.

Copyright of Summa, Animali da Compagnia is the property of Point Veterinaire Italie s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Giant esophageal leiomyomas are rare neoplasms with an imprecise clinical course; most originate from the middle and lower portion of the organ. Imaging and endoscopic tests are used to identify the proper diagnosis and treatment. The purpose of this work, based on a new case, is to share and disseminate a new report of giant esophageal leiomyoma. The patient was admitted for dysphagia. Diagnostic tests included radiography of the esophagus, stomach, and duodenum, upper digestive endoscopy, computed tomography, and MRI. The patient underwent surgery by right thoracotomy, enucleation of a 10x6x5cm tumor was performed, and the integrity of the mucosa was verified. There was no evidence of malignancy in the histopathological study. He was discharged eight days after surgery. Thoracotomy with enucleation of the esophageal tumor is an effective procedure to treat patients with giant leiomyoma. [ABSTRACT FROM AUTHOR]

Postoperative pain is a frequent problem that can be experimented by up to 80% of the patients who undergo surgery. Poor postoperative pain control is associated with an increased risk of persistent pain months later. There are studies showing the persistence of posthoracotomy pain of 37.6% at 4 months follow-up. The role of perioperative pregabalin in the prevention of chronic neuropathic pain in thoracic surgery is a subject of constant discussion. However, a recent meta-analysis has shown a significant improvement in neuropathic pain in thoracotomies. With regard of this, we present a patient who underwent a thoracotomy and developed neuropathic pain in the postoperative period, which, thanks to early diagnosis, treatment and follow-up has been able to avoid chronification after 3 months. [ABSTRACT FROM AUTHOR]

Estudar o impacto em linfócitos causado pelo uso da dexmedetomidina associada à morfina para analgesia pós‐toracotomia. Um total de 118 pacientes utilizando Analgesia Intravenosa Controlada pelo Paciente (AICP) pós‐toracotomia em nosso hospital, de março de 2016 a julho de 2018, foram selecionados aleatoriamente e divididos em dois grupos: o Grupo Combinado [COM, 57 pacientes que receberam dexmedetomidina (1,0 μg.kg‐1 de peso corpóreo) associada à morfina (0,48 mg.kg‐1 de peso corpóreo)] e o Grupo Morfina [MOR, 61 pacientes, que receberam somente morfina (0,48 mg.kg‐)]. Os valores dos subconjuntos de linfócitos (CD3+, CD4+ e CD8+) e das células NK no sangue periférico desses dois grupos foram medidos por citometria de fluxo FACSCalibur em diferentes momentos do estudo [antes da indução anestésica (T0), imediatamente após extubação traqueal (T1), 12 horas após a cirurgia (T2), 24 horas após a cirurgia (T3), 48 horas após a cirurgia (T4), 72 horas após a cirurgia (T5) e 7 dias após a cirurgia (T6)]. As doses de morfina do momento T3 ao T5 e as reações adversas entre os dois grupos também foram registradas e comparadas. O nível de CD3+ e a razão CD4+/CD8+ de T2 a T5, e o nível de CD4+ e as células NK de T3 a T5 do Grupo COM foram significantemente maiores (p < 0,05) quando comparados ao Grupo MOR. A dose de morfina no pós‐operatório e a incidência de prurido, náusea e vômito no pós‐operatório foram significantemente menores no grupo MOR (p < 0,05). Dexmedetomidina combinada com morfina para AICP no período pós‐toracotomia pode melhorar a função dos linfócitos, reduzir o consumo de morfina e diminuir reações adversas durante a analgesia. This study aimed to investigate the impact of post‐thoracotomy analgesia with dexmedetomidine and morphine on immunocytes. A total of 118 patients with post‐thoracotomy Patient‐Controlled Intravenous Analgesia (PCIA) in our hospital from March 2016 to July 2018 were randomly selected and divided into the Composite (COM) Group (57 patients administered with dexmedetomidine [1.0 μg.kg‐1 body weight] and morphine [0.48 mg.kg‐1 body weight]) and the Morphine (MOR) Group (61 patients administered with morphine [0.48 mg.kg‐1). The values of lymphocyte subsets (CD3+, CD4+, and CD8+) and Natural Killer cells in the peripheral blood of these two groups were detected by FACSCalibur flow cytometry at different time points (before anesthesia induction [T0], immediately after tracheal extubation [T1], 12 hours after surgery [T2], 24 hours after surgery [T3], 48 hours after surgery [T4], 72 hours after surgery [T5], and 7 days after surgery [T6]). The doses of morphine at T3 to T5 and the adverse reactions between the two groups were also recorded and compared. The CD3+ level and the CD4+/CD8+ ratio at T2 to T5 and the CD4+ level and NK cells at T3 to T5 were significantly higher in the COM Group than in the MOR Group (p < 0.05). The postoperative morphine dose and the incidence of postoperative itching, nausea, and vomiting were significantly lower in the COM Group than in the MOR Group (p < 0.05). Dexmedetomidine combined with morphine for post‐thoracotomy PCIA can improve the function of immunocytes, reduce morphine consumption, and reduce the adverse reactions during analgesia induction. [ABSTRACT FROM AUTHOR]

Objective: To compare the chest tube drainage by the same thoracotomy intercostal space with the traditional approach in patients undergoing muscle-sparing thoracotomy. Methods: We evaluated 40 patients aged ≥18 years who underwent elective muscle sparing thoracotomies. Patients were divided into two groups of 20 patients. One group underwent thoracic drainage by the same intercostal space of thoracotomy and the other by traditional chest drainage approach. Results: The mean length of hospital stay for the intercostal drainage group in the intensive care unit was 1.5 day (1.0 to 2.0 days) and 2.0 days (25.1 to 3.0 days) for the traditional chest drainage group (p=0.060). The intercostal drainage group had mean length of hospital stay (p=0.527) and drainage (p=0.547) of 4 days, and the traditional chest drainage group and 2 and 5.5 days, respectively. Dipirona and tramadol doses did not differ between groups (p=0.201 and p=0.341). The mean pain scale values on first postoperative was 4.24 in the drainage by the same intercostal group and 3.95 in the traditional chest drainage (p=0.733). In third postoperative day, mean was 3.18 for the first group and 3.11 for the traditional group (p=0.937). In the 15th day after surgery, drainage by the incision was 1.53 and the traditional chest drainage was 2.11 (p=0.440), 30th days after drainage by incision was 0.71 and traditional chest drainage was 0.84 (p=0.787). Complications, for both groups were similar with 30% in proposed drainage and 25% in traditional approach (p=0.723). Conclusion: Drainage by the same thoracotomy intercostal space was feasible and results 30 days after surgery were not inferior to those of the traditional chest drainage approach. [ABSTRACT FROM AUTHOR]

Las malformaciones pulmonares corresponden a distintas anomalías del sistema respiratorio que se presentan con baja incidencia (1 en cada 10.000 a 35.000 embarazos), dentro de las que se incluye a las Malformaciones Pulmonares Congénitas y de la vía aérea (MCPA), antes conocida malformación adenomatosa quística, secuestros pulmonares, lesiones híbridas y enfisema lobar congénito. Durante los últimos años se ha visto un aumento en el diagnóstico antenatal y avances en el conocimiento de la patogénesis e historia natural de esta enfermedad, pero aún existe controversia en cuanto a la clasificación a utilizar y a su tratamiento. La mayoría de los recién nacidos (90%) son asintomáticos al nacer, pero hay malformaciones que generan serias complicaciones para el feto o recién nacido. El propósito de esta publicación es hacer un resumen actualizado de la historia natural, diagnóstico y tratamiento de las MCPA.

Axillary thoracotomies are among the most described and modified in the history of surgery. Despite the sustained development of video-assisted thoracic surgery, the role of classic thoracotomies in current surgical practice is unavoidable, especially when minimally invasive options are not available. Extended posterior vertical axillary thoracotomy emerged almost 30 years ago from the introduction of innovative modifications to axillary thoracic incisions previously described. An extensive literature review makes it possible to affirm that an axillary thoracotomy, which contains all the distinctive features that the one presented herein, has never been reported before. Its main advantages are discussed in relation to the decrease in the operating time and complications during and after surgery. [ABSTRACT FROM AUTHOR]

Resumo Justificativa e objetivo O bloqueio paravertebral torácico é uma técnica regional opcional para o alívio da dor pós‐toracotomia, deste modo diminui o consumo de opioides, náuseas e vômitos no pós‐operatório, tontura, depressão respiratória e custos com saúde. O objetivo deste estudo foi investigar os efeitos de bupivacaína isolada e bupivacaína + dexmedetomidina no escore de dor pós‐operatória e no consumo de analgésicos em pacientes submetidos à toracotomia sob bloqueio paravertebral guiado por ultrassom. Material e método Noventa e três pacientes, ASA I-II, com idades entre 18 e 65 anos, foram incluídos no estudo e programados para cirurgia torácica. Antes da indução anestésica, o procedimento de bloqueio paravertebral foi realizado por um anestesista com o uso de ultrassom. Os casos foram estratificados aleatoriamente em três grupos. O procedimento de bloqueio paravertebral foi realizado com injeção de 20 mL de bupivacaína a 0,5% no Grupo B (n = 31) e de 20 mL de bupivacaína a 0,5% + 1 mL de dexmedetomidina (100 μg) no Grupo BD. O Grupo C recebeu morfina intravenosa via analgesia controlada pelo paciente sem bloqueio paravertebral. Os escores de dor pós‐operatória foram registrados na sala de recuperação e no pós‐operatório usando a escala VAS. Parâmetros hemodinâmicos, efeitos adversos e consumo de morfina também foram registrados. Resultados Não houve diferença significativa entre os grupos B e C em relação a efeitos adversos intraoperatórios, como bradicardia e hipotensão, enquanto esses efeitos adversos foram significativamente maiores no Grupo BD (p = 0,04). Os escores VAS em repouso e movimento foram significativamente menores no Grupo BD em relação ao Grupo C (p < 0,001). O consumo total de morfina foi significativamente menor nos grupos B e BD em comparação com o Grupo C (p < 0,001). No Grupo BD, a frequência cardíaca e a pressão arterial média foram menores, mas esse resultado não foi clinicamente significativo (p < 0,05). Conclusão A adição de dexmedetomidina à bupivacaína reduz os escores de dor pós‐operatória e o consumo de morfina em pacientes submetidos à toracotomia sob bloqueio paravertebral guiado por ultrassom. Abstract Background and objective Thoracic paravertebral blockade is an alternative regional technique for comforting post‐thoracotomy pain, thereby decreasing opioid consumption, postoperative nausea and vomiting, dizziness, respiratory depression and health care costs. The objective of this study was to investigate the effects of bupivacaine and bupivacaine plus dexmedetomidine on postoperative pain score and analgesic consumption in thoracotomy patients who had undergone ultrasonography‐guided paravertebral blockade. Material and method 93 ASA I–II patients aged 18–65 years were included in the study and scheduled for thoracic surgery. Prior to anesthesia induction, the paravertebral blockade procedure was performed by an anesthetist with ultrasonography. Cases were randomly stratified into three groups. The paravertebral blockade procedure was performed with 20 mL 0.5% bupivacaine injection in Group B (n = 31) and 20 mL 0.5% bupivacaine + 1 mL dexmedetomidine (100 μg) injection in Group BD. Group C received postoperative i.v. morphine via patient‐controlled analgesia without paravertebral blockade. Post‐operative pain scores were recorded in the recovery room and post‐operatively using a VAS. Hemodynamic parameters, adverse effects and morphine consumption were also recorded. Results No significant difference was determined between Group B and Group C regarding intra‐operative adverse effects such as bradicardia and hypotension, while these adverse effects were significantly higher in Group BD (p = 0.04). VAS scores with rest and upon movement were significantly lower in Group BD compared to Group C (p < 0.001). Total morphine consumption was significantly lower in both Group B and Group BD in comparison with Group C (p < 0.001). In Group BD, HR and MAP were lower, but this was not clinically significant (p < 0.05). Conclusion The addition of dexmedetomidine to bupivacaine lowers postoperative pain scores and morphine consumption in thoracotomy patients who receive ultrasonography guided paravertebral blockade. [ABSTRACT FROM AUTHOR]

El drenaje venoso pulmonar anómalo parcial es una cardiopatía infrecuente especialmente cuando afecta a las venas pulmonares izquierdas. El abordaje quirúrgico más utilizado en cirugía cardiaca es vía esternotomía media y circulación extracorpórea. Pero existen ciertas patologías en las que puede ser más recomendable otro tipo de acceso (toracotomía) y no siempre es preciso el uso de la circulación extracorpórea. Presentamos un caso de un paciente de 3 años con drenaje venoso pulmonar anómalo izquierdo que drena a una vena vertical que desemboca en la vena innominada. Para su reparación realizamos un abordaje a través de una toracotomía posterolateral y realizamos el procedimiento sin circulación extracorpórea. El propósito de esta publicación es contribuir a la difusión de esta técnica.

RESUMO Objetivo: determinar, em pacientes pediátricos portadores de neoplasias malignas, as características de nódulos pulmonares identificados à tomografia computadorizada, capazes de diferenciar nódulos benignos de metástases. Métodos: estudo retrospectivo de pacientes submetidos a ressecções pulmonares de nódulos diagnosticados como metástases em um período de sete anos. Achados de tomografia e da cirurgia, assim como resultados dos exames anatomopatológicos foram comparados. Resultados: nove pacientes, submetidos a 11 intervenções cirúrgicas, foram estudados. Entre as variáveis estudadas, apenas o tamanho do nódulo, maior do que 12,5mm provou ser estatisticamente significante para predizer malignidade. Conclusão: esse estudo sugere que, entre as características tomográficas de nódulos pulmonares de crianças portadoras de neoplasias malignas, apenas o tamanho da lesão foi preditor de malignidade.

Abstract The Glenn operation involving anastomosis of the superior vena cava to the pulmonary artery has been performed for palliative operations of many cyanotic congenital heart diseases in addition to the single ventricle since the 1960s. The classic procedure is done via median sternotomy and cardiopulmonary bypass. The benefits of this procedure without the use of cardiopulmonary bypass remain mixed within reported series. Cases using this approach and off-pump technique together in Latin-America have not yet been reported in the scientific literature.

Objetivos: La reparación de la coartación aórtica con/sin hipoplasia de arco en neonatos/lactantes es controvertida. Los abordajes quirúrgicos mediante toracotomía o esternotomía, respectivamente, evitan o requieren circulación extracorpórea. Presentamos nuestros resultados, analizando si existen diferencias significativas entre ambas técnicas. Métodos: Estudio retrospectivo; 132 lactantes con anatomía de corazón biventricular y cirugía del arco aórtico durante el período 2004-2014: 65-esternotomías y 67 toracotomías. En las esternotomías usamos rutinariamente perfusión cerebral selectiva (PCS). La parada circulatoria es excepcional. Resultados: Grupos no homogéneos: el abordaje esternal asocia más cardiopatía, más hipoplasia de arco y mayor complejidad. Técnicas quirúrgicas: por esternotomía 83% pacientes recibieron anastomosis término-lateral y por toracotomía 87% anastomosis termino-terminal. Mortalidad hospitalaria: 10,7% esternotomía y 4,5% toracotomía (ns). Morbilidad hospitalaria: sin diferencias en complicaciones neurológicas ni en recoartación precoz, pero las esternotomías tienen más lesión del nervio recurrente laríngeo y mayores estancias hospitalarias que las toracotomías (p

The dehiscence after median transesternal sternotomy used as surgical access for cardiac surgery is one of its complications and it increases the patient's morbidity and mortality. A variety of surgical techniques were recently described resulting to the need of a classification bringing a measure of objectivity to the management of these complex and dangerous wounds. The different related classifications are based in the primary causal infection, but recently the anatomical description of the wound including the deepness and the vertical extension showed to be more useful. We propose a new classification based only on the anatomical changes following sternotomy dehiscence and chronic wound formation separating it in four types according to the deepness and in two sub-groups according to the vertical extension based on the inferior insertion of the pectoralis major muscle.