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Dear Jose,

Was it a chest tube draining the operative site?
Was the operation done through a median sternotomy and laparotomy or a left
anterolateral thoracotomy-laparotomy?

BTW, Dr. Lyman Brewer in the book by the US Army Surgery in World War II
proposed a transdiaphragmatic approach in exploring left-sided
thoracoabdominal wounds. "By the end of the war, it was the opinion in the
Mediterranean theater --- an opinion shared by the more experienced of the
thoracic surgeons in the European theater --- that whenver it was practical,
thoracotomy with transdiaphragmatic repair of all accessible abdominal
injuries was infinitely the procedure of choice ... The same general
principle was applicable to wounds of the upper right quadrant of the
abdomen, but the extent of surgery possible in this quadrant was, for
anatomic reasons, much less than on the left side."

Jose Luis J. Danguilan, MD
Manila, Philippines

**On 1/28/09, josemaya01 <josemaya01 at prodigy.net.mx> wrote:

> Dear All:
> Today at rounds at the ICU I received a male patient, who was stabbed in
> his chest , had a right ventricular laceragtion which was repaired, and also
> a diaphragmatic injury which was repaired, and a gastric perforation which
> was also repaired, so far so good, but what caught my eye was the fact that
> he had a mediastinal drain connected to a pleurevac system.
> There has been discussion with the resident who placed it and so far no
> justification of why it is hooked to a pleurevac system, anyb ody ever heard
> of such thing or am I missing on something?
> José Mayagoitia, MD, FACS
> Hospital General de Mexicali, México
> --
> trauma-list : TRAUMA.ORG
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