The Oldest Medical and scientific document known is the Edwin
Smith Surgical Papyrus. This in thought to be an undated version of documents
prepared by in around 3000 BC. Greek soldiers in the Trojan War, in the first
century AD, were remove from the battle field and looked after in certain
barracks or ships which seemed to be the earliest trauma centers for
pneumothorax. Thoracic trauma has been the major emergency in war and cause for
mortality.
Breast augmentation is one of the most common authentic surgeries performed worldwide. Most of the common complications associated with it are
capsular contracture, hematoma, bruising, infection breast asymmetry, implant
rotation, etc. Pneumothorax generally
speaking is regarded as a rare complication. It occurs at a rate of less than
1:1.000. The literature review indicates that
It may be occurring more frequently than previously thought.
Various mechanisms of its notation have been observed and hypothesized. The
obvious ones are direct trauma to the pleura.
during surgery, needle penetration during local infiltration,
and thermal damage from diathermy. Barotrauma during implant insertion has also
been suggested as another mechanism, as' are high ventilation pressure, the
presence of pleural blebs, oxygen rush when changing oxygen-cylinders, and
defective pressure valve in the anesthetic circuit.
No large multicenter studies have been done that would help
in revealing the true extent of the problem mainly due to the nature of plastic
surgery practice. When it occurs it is most distressing for the patient and
very concerning to the surgeon. The rate of litigation in relation to
pneumothorax during breast augmentation is about 10%.
Anatomy
Doctor beware ... as we all know the anatomy is
not always the same. One woman's pectoralis major can be thin, another thick,
another virtually nonexistent. The pectoralis minor is often fused to the major
or can have a broad origin. The insertion of the pectoralis major into the
inframammary fold can vary, making it difficult to get into the submuscular
plane. Digital confirmation of the ribs and direct vision of the pectoralis
edge andlor serratus muscles are recommended to avoid cutting through the intercostal
muscle and creating a potential for pneumothorax.
