[HSF] costal cartilage

Wed May 9 11:15:56 EDT 2007

Dear Murtaza
I do quite agree with your opinions. Variables are many, and the subct of
study is highly subjective. I do also agree that stretching and crushing and
bad tissue handling do add to the problem. never against that.
all what I wanted to negate is the point that cartilage sound surgical
manipulations are painful. still, some harsh handling of the Costal
cartilages might be very painful. yet the reason would be the non sound
surgical manipulations rather than the cartilage per se.
I think we all agree to the same fact, though looking at it from a different
prespective.
Thank you for sharing your opinion.

Kindest Regards

NFA

On 5/9/07, murtaza chishti <cmurtaza at hotmail.com> wrote:
>
>
> ajit,nasser
>
> bothersome and sometimes disabling post surgery pain is occasionally seen
> with nearly every type of incision and it is impossible IMHO to blame any
> one type of tissue within the chest wall. it is my impression that limited
> access incisions, involving  forcefull retraction and cosequent exessive
> tissue stretching/ crushing , are more prone to the problem.
> unfortunately,
> it is a hard thing to study due to highly variable pain threshold among
> people, its subjective nature  and difficulties in quantifying it. till
> some
> one finds the answer we will be guided by our individual experinces, and
> yes
> biases.
>
> murtaza
>
> >From: "Nasser F. Abou'Seada" <nfaabouseada at gmail.com>
> >Reply-To: OpenHeart-L at lists.hsforum.com
> >To: OpenHeart-L at lists.hsforum.com
> >Subject: Re: [HSF] costal cartilage
> >Date: Wed, 9 May 2007 02:31:56 -0500
> >
> >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
> >_______________________________________________
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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC