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Removal Of Double Pointed Tacks
Category: MECHANICAL PROBLEMS OF BRONCHOSCOPIC FOREIGN BODY EXTRACTION
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
If the tack or staple be small,
and lodged in a relatively large trachea a version may be done. That
is, the staple may be turned over with the hook or rotation forceps
and brought out with the points trailing. With a long staple in a
child's trachea the best method is to coax the intruder along gently
under ocular guidance, never making traction enough to bury the point
deeply, and lifting the point with the hook whenever it shows any
inclination to enter the wall. Great care and dexterity are required
to get the intruder through the glottis. In certain locations, one or
both points may be turned into branch bronchi as illustrated in Fig.
88, or over the carina into the opposite main bronchus. Another method
is to get both points into the tube-mouth. This may be favored, as
demonstrated by my assistant, Dr. Gabriel Tucker, by tilting the
staple so as to get both points into the longest diameter of the
tube-mouth. In some cases I have squeezed the bronchoscope in a vise
to create an oval tube-mouth. In other cases I have used expanding
forceps with grooved blades.
[FIG. 88.-Schema illustrating podalic version of bronchially-lodged
staples or double-pointed tacks. H, bronchoscope. A, swollen mucosa
covering points of staple. At E the staple has been manipulated upward
with bronchoscopic lip and hooks until the points are opposite the
branch bronchial orifices, B, C. Traction being made in the direction
of the dart (F), by means of the rotation forceps, and counterpressure
being made with the bronchoscopic lip on the points of the staple, the
points enter the branch bronchi and permit the staple to be turned
over and removed with points trailing harmlessly behind (K).]
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