Change of Heart *graphic photo*

So far in my project, I have been observing open heart surgeries, but since Dr. Patel is a cardiothoracic surgeon, I have the privilege to watch his thoracic procedures as well. For those of you who may be confused about the difference between cardiothoracic and thoracic, thoracic surgeons manage the conditions of anything in the chest cavity except the heart while cardiothoracic surgeons manage everything in the thorax with a focus on the heart. This week, Dr. Patel changed things up a bit and focused on thoracic surgeries rather than open heart surgeries. I observed three thoracotomies, procedures in the pleural space in the chest.

There are many reasons as to why someone may need a thoracotomy. To name a few, a surgeon may need to access the lungs and diaphragm in order to remove a portion of the lung, treat trachea or esophagus disorders, remove blood clots and pus from the chest, or diagnose a lung or chest disease.

In this post, I will briefly discuss the thoracotomy I observed today and touch on the general uses, strengths, and weaknesses of monofilament polypropylene sutures to begin my suture project.

Today, Dr. Patel performed a right thoracotomy with decortication. Decortication is the removal of the pleural membrane surrounding the lungs, and may be necessary if the patient has empyema, which was the case. Empyema is a condition where pus builds up in the pleural space between the lungs and chest wall. The pus is a product of infection of the lungs usually caused by pneumonia, and can cause breathing problems since the lungs can't fill with air completely.

Decortication

Empyema (arrow pointing to pus build-up)

To begin my suture experiment, I will spend the next two weeks explaining the advantages and disadvantages of each suture I will use. Today, I will talk about monofilament polypropylene sutures. These sutures are specially made for cardiac surgery because they can easily pass through cardiac tissue and induce a minimal tissue reaction. Also, they have a higher tensile strength (resistance to breaking under tension) than nylon sutures and may be easier to handle due to their ability to slightly stretch when passing through cardiac tissue. However, polypropylene sutures don't have the most reliable knot holding security.

The blue color of Polypropylene allows for easy visualization during surgery

Next week, I will briefly talk about monofilament nylon sutures and the surgeries I will observe!