[HSF] costal cartilage

[Nasser F. Abou'Seada]

Dear Ajit
I find it interesting to coin cartilage to chronic pain. IMH experience, in
chest wall reconstruction, and particularly Sternal reconstruction all the
cartilages are reseected, cut, replaced, with no chronic pain. als in many
anterior chest incisions, known to thoracic Surgeons, cartilage is resected
and resutured again. In anterior / anterolateral thoracotomy for TVMC, the
cartilage of the 5th ribs in many tight cases is wedge resected -by cautery-
to prevent uncalculated rib fracture in many tight rigid rib cases.

Subperiosteal resection, cutting, replacement, all are well known
technicalities, long practised with no chronic pain.

Certainly pain is there is some cases associated with manouvers on sternal
cartilages, certainly the mechanism is related to another variable
confounded by the fact that the cartilage was manipulated.

thank you for sharing your experience with us

Kindest Regards

NFA

On 5/9/07, Ajit Damle <damle at cableone.net> wrote:
>
> Unfortunately my experience is different. Now I try very hard to avoid
> costal cartilage injury to prevent chronic pain. I have had some patients
> from my mid-cab days........ not pleasant.
>
> In general though, the higher the incision in the chest wall the less
> (acutely and chronically) painful it is.
>
> Ajit Damle
>
>
>
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Zhandong Zhou
> Sent: Tuesday, May 08, 2007 1:42 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Bicuspid aortic valve and dilated ascending aorta
>
> These patients have very little pain as cartilage has no nerve supply.
> BTW,
> the cartiliage is transected and reattached with heavy suture.
>
> Z Zhou
>
>
> ----- Original Message -----
> From: <Hgrmd at aol.com>
> To: <OpenHeart-L at lists.hsforum.com>
> Sent: Tuesday, May 08, 2007 6:23 AM
> Subject: Re: [HSF] Bicuspid aortic valve and dilated ascending aorta
>
>
> > Zhou,
> >  I would bet you that with resecting the cartilage of the 3rd ICS,  your
> > patients have a lot more pain than with an upper
> sternotomy.  Other  than
> > cosmesis and preventing a sternal infection, your approach sounds
> > relatively painful
> > and technically difficult.  In contrast to your  approach, the upper
> > sternal
> > split is ideal for redos.
> > Hal
> >
> >
> >
> > ************************************** See what's free at
> > http://www.aol.com.
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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC