J Thorac Cardiovasc Surg 2006;131:1423-1424
© 2006 The American Association for Thoracic Surgery
Reply to the Editor
Robert James Cerfolio, MD
Cardiothoracic Surgery, University of Alabama at Birmingham, 1900 University Blvd, THT 712, Birmingham, AL 35294
We appreciate the letter from Dr Maniwa and colleagues. The authors have tried to confirm our results in their own study. The authors have retrospectively, I believe, compared the pain scores in patients using a "6-point scale pain score." My understanding from their letter is that they assessed the pain for "4 hours after lung surgery." If I understand their study correctly, and I apologize if I do not, I invite them to perform a prospective randomized study between 2 similar groups and to compare the patients' pain several days, weeks, and even months after the operation by using an objective reproducible scale. As for their explanation as to why they found no difference, I would cite the methodology difference between our 2 studies. Importantly, we strongly disagree that cutting the rib leads to less pain. There is no data for that concept, and our opinion is that, if anything, it might lead to more pain because the intercostal nerve might be injured when the rib is shingled. We used to perform our thoracotomies in this manner but changed our technique in 1997. Finally, the authors also decided to analyze the blood loss difference between the patients who had an intercostal muscle flap harvested compared with that in the group that did not have a flap. In our experience there is almost no blood loss during the harvesting of an intercostal muscle flap. As described in our article, we do it using the Bovie and hug the undersurface of the top rib so as to avoid the neurovascular bundle. The bundle is very close, and it is not uncommon to have small side branches that have to be bovied, but the amount of bleeding is negligible. In this respect our studies have similar findings. We thank Dr Maniwa and his colleagues for their interest in our article and wish them well.
