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Thu Jan 25 11:25:21 GMT 2007

Good post.   I will be giving a follow up today.     
Sent via BlackBerry, return via KMattox at aol.com

-----Original Message-----
From: "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za>
Date: Thu, 25 Jan 2007 06:55:21 
To:"Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Subject: FW: Sunday's Case  The plot gets more COMPLEX

Ken

This was one of my posts - probably the most relevant

Tim

-----Original Message-----
From: Hardcastle, Tim, Dr <tch at sun.ac.za> 
Sent: Wednesday, January 24, 2007 7:24 AM
To: 'Trauma & Critical Care mailing list'
Subject: RE: Sunday's Case The plot gets more COMPLEX

Ken

In our recent experience (du Toit DF, Strauss DC, Blaszczyk M, de Villiers R, Warren BL.Endovascular treatment of penetrating thoracic outlet arterial injuries. Eur J Vasc Endovasc Surg 2000;19:489-495 & du Toit DF, Leith JG, Strauss DC, Blaszczyk M, Odendaal J de V, Warren BL. Endovascular management of traumatic cervicothoracic arteriovenous fistula. Br J Surg. 2003 Dec;90(12):1516-21) we would stent the brachiocephalic/innominate injury, so avoiding the need for sternotomy and then would manage the oesophagus on its own merit through likely a right thoracotomy with debridement and primary single layer monofilament absorbable (PDS) repair, placing an NGT through the repair to feed the patient. The repair would be buttressed by probably a pleural flap in our hands. We would look at the trachea / main bronchi at the same time - but since there is no air leak we are very conservative with these if injured. Would place bilateral chest tubes and a mediastinal suction drain - Blake's or Jackson-Pratt.

Just my 2c
Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
Now results of the tests are coming back.   Believe me (I am  totally telling 
the truth) the CT and CTA and CT reconstructions did not help  either me, the 
radiologist, or ANYONE in confirming or denying any additional  issues over 
the plane chest X-ray.
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Sunday's Case The plot gets more COMPLEX