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Avoiding Chest Wall Morbidity in Outpatient Microvascular Free-Flap Breast Reconstruction.

J Clin Med

January 2025

My Houston Surgeons, 9230 Katy Freeway, Suite 600, Houston, TX 77055, USA.

Removal of the rib and adjacent cartilage is a common step for exposure of the recipient chest vessels in free-flap breast reconstructions. However, this adds both short- and long-term morbidity to the procedure. We describe our experience in avoiding rib removal in microvascular breast reconstruction.

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: Video-assisted thoracoscopic surgery (VATS) is associated with less postoperative pain than traditional open thoracotomy. However, trocar and chest tube placement may damage the intercostal nerves, causing significant discomfort. An ultrasound-guided serratus anterior plane block (SAPB) is a promising mode of pain management; this reduces the need for opioids and the associated side-effects.

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Intercostal artery aneurysms are a type of vascular abnormality that poses a potential risk of rupture, which could lead to life-threatening hemothorax. This case report presents a young male who experienced a rupture of an intercostal artery aneurysm and subsequently suffered from a massive hemothorax after engaging in strenuous physical activity. The current case study sheds light on the difficulties and lessons learned in managing such cases in peripheral settings, including the dilemma of whether to insert an intercostal chest drain (ICD).

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Purpose: Traumatic abdominal intercostal/flank hernias present a perplexing challenge for surgeons seeking to repair them. There has been a paucity of studies describing robotic repairs of such hernias. We aim to evaluate the effectiveness of the Robotic-assisted Extended Total Extraperitoneal/Transversus Abdominus Release (rETEP/TAR) method in repairing traumatic abdominal intercostal and flank hernias.

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Background: Regional anesthesia techniques that provide analgesia to the entire lateral abdomen are limited. We present a modified external oblique intercostal block for complete lateral abdominal analgesia with a single injection.

Case: We performed a modified version of the external oblique intercostal block unilaterally at the tenth rib along the mid-axillary line in three patients undergoing robot-assisted partial nephrectomy (two single injections, one catheter placement) and tested the technique on a cadaver with 20 ml of dye bilaterally.

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