Paraplegia associated with the use of oxidized cellulose in posterolateral thoracotomy incisions : A case report

Bunthoon Nonthasoot, D. of Surgery, F. of Medicine, PSU.
Puttisak Puttawibul, Assoc. Prof., D. of Surgery, F. of Medicine, PSU.
Thakul Oearsakul, D. of Surgery, F. of Medicine, PSU.
Corresponding e-mail : pputtisa@ratree.psu.ac.th

Presented : The 16th Annual Academic Meeting, Faculty of Medicine, PSU, Hat Yai, Songkhla, 16-18 August 2000
Key words : paraplegia associated, oxidized cellulose, posterolateral thoracotomy incisions

The unexpected appearance of paraplegia after routine thoracotomy for condition unrelated to the spine or spinal cord is a surgical disaster of the highest order. This case is reported to alert surgeons of this potential complication when oxidized cellulose is used to achieve hemostasis in the posterior angle of the thoracotomy incisions. We presented a 64-year-old woman with progressive dysphagia and weight loss for 6 months. Esophagoscopy and biopsy showed squamous cell carcinoma of mid thoracic esophagus. She was undergone three phase esophagectomy. At the first phase, an operation was performed through a routine right posterolateral thoracotomy in the fifth intercostal space, the pleural cavity was opened on the top of the sixth rib to the tip of the transverse process posteriorly. Venous bleeding from the top of the sixth rib could not be controlled by electrocautery, and the narrow angle precluded ligation of the source. During operation, bleeding was controlled by gauze packing. At the end of operation, there was ongoing bleeding and 2 pieces of oxidized cellulose was placed in the posterior angle of the wound, finally bleeding ceased. The chest wall was closed with large vicryl pericostal sutures.
Early in the postoperative period, she could move her legs but neurological examination was not performed in details. At 46 hours after operation, she was unable to move her legs. An emergency MRI showed a mass, suspected hematoma, compressed spinal cord at T-5 level. Emergency laminectomy with cord decompression and evacuation of hematoma was carried out. The evacuated material in-cluded a portion of oxidized cellulose placed in the posterior angle at thoracotomy. After operation, she ultimatedly regained function in her left leg but continued to have a monoplegia involving her right leg.
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