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Wed Nov 16 14:50:04 GMT 2005

Yes.  I try to make sure that there is no leaks from
the staple line, regardless of why u r resecting that
part of the lung.  Particularly if they will be on the
ventilator and receiving positive pressure.  Leaks
will not close on positive pressure very easily and
these can develop into major problems otherwise.  If u
can't oversew every small air leak, other things can
help like fibrin glue, tissel, etc.  And get them off
the ventilator ASAP.

--- Dean Lutrin <deanlutrin at gmail.com> wrote:

> Dear List,
> 
> I have a question regarding tractotomy for gunshot
> wound to the lung. I did
> one the other day with one of my seniors who is not
> a dedicated trauma
> surgeon. We used a GIA 80 stapler across the tract
> and opened it up nicely.
> We managed to oversew all the bleeders and we left a
> dryish field. We
> managed to oversew most of the major air leaks but
> we left a few small ones.
> The senior I was with was not too concerned about
> these small leaks and said
> that they would close on their own. The patient is
> still ventilated in ICU
> with significant bubbling from the ICD on that side.
> 
> My question is whether you ALWAYS make the effort to
> make sure there is
> absolutely no leakage of air across the injured
> tract or do you tolerate
> small air leaks with the hope that they will close?
> 
> Thanks
> 
> Dean Lutrin
> Surgical registrar
> JHB, SA
> 
> --
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> 

Kumash Patel, MD
Assistant Professor of Surgery
Administrative Chief of Surgery @ University Hospital
Trauma / Critical Care / General Surgery
Tulane University Hospital
1430 Tulane Ave, SL-22
New Orleans, Louisiana 70112

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