Ann Thorac Surg 2004;77:1467-1468
© 2004 The Society of Thoracic Surgeons
How to do it
A simplified technique for closing thoracostomy incisions
Bernard G. Vasseur, MDa*
a Department of Surgery, Division of Thoracic Surgery, University of Dentistry and Medicine of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
Accepted for publication June 25, 2003.
* Address reprint requests to Dr Vasseur, Division of Thoracic Surgery, PO Box 19, New Brunswick, NJ 08903-0019, USA
e-mail: bernard.vasseur{at}umdnj.edu
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Abstract
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A technique for closure of chest tube incisions is presented. This procedure is simple to perform with an excellent cosmetic result and a reliable prevention of air entry.
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Introduction
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The safe and cosmetic closure of a chest tube incision has been of interest to surgeons for many years [1] [2]. Recent advances in minimally invasive surgery emphasize even more the need for aesthetic wound closure.
Several methods for wound closure have been proposed. A common method is to simply cover the wound with a Vaseline gauze and adhesive tape after removing the chest tubes. Although it does prevent air entry, the cosmetic result is unreliable with the healing via granulation. Indeed to obtain a cosmetic incision it is necessary to have a good approximation of the skin edges. To that effect well-known closure techniques have been proposed. They all involve some degree of surgical skill: suturing [1–3], stapling, or gluing after the chest tubes are removed.
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Technique
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Before the chest tubes are inserted and after making all the skin incisions a 2-0 Vicryl (Ethicon, Somerville, NJ) is placed subcutaneously starting one inch away from the first incision (Figure 1).
The suture is aimed deep into the incision and is carried through the subcutaneous and partially subcuticular tissues. This step does not require more than three needle passes. The needle exits one inch away from the incision, the suture staying loose. No attempts are made to place a knot at either end of the suture. The same suture is used in a similar manner across the other chest tube incisions leaving a bridge of 2-0 Vicryl between them. The chest tubes are then inserted and secured with a simple 2-0 silk suture attached directly to the tube. After cutting the silk suture at the time of chest tubes removal the bridge between incisions (or one end of the suture if only one chest tube was inserted) is pulled (Figure 2)
resulting in a secure wound closure (Figure 3).
The subcutaneous part of the suture and its dragging forces are usually sufficient to allow a permanent wound closure without further maneuvers. If necessary the tension on the suture may be readjusted using a small tape. Often residual clots are removed under direct vision and a small dressing is used to cover each incision. A week later the Vicryl stitch is pulled out without difficulty.
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Comment
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The advantages of this technique are the excellent cosmetic results and the easy and reliable prevention of air entry even when several tubes are removed at the same time.
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References
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- Roe BB. Improved technique for closure of thoracostomy incision. Surg Gynecol Obstet 1965 Oct;121:845–6
- Flege JB Jr. A simple technique of closing thoracostomy incisions. Surg Gynecol Obstet 1967 Apr;124:846–7
- Simon RR, Bailey TD Jr, Abraham E, Brenner B. A new technique for securing a chest tube. Ann Emerg Med 1982 Nov;11:619–21
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Abstract
Introduction
