Semantic sMatter #1

As we get comfortable with our specialty, there is a tendency to get a little loose with our language, which can have unintended outcomes. Additionally there is often an assumption that everyone understands what we mean when we use a particular term, or we may feel that we should understand it and therefore not feel brave enough to clarify an unfamilar one. We are constantly berated for not putting technical terminology into layman’s terms for Joe and Joanna Public, which can end up with us forgetting to use those technical terminologies when conveying important information to colleagues.

So, to bring some semantics back into critical care, we are going to buff up your clinical lexicon, put clarity into your vocabulary and enhance the elegance of your diction – So you can talk gooderer!

Try this one on for size: “The Clagett procedure and the Eloessar flap“

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What is a Clagett procedure and how is it related to an Eloessar flap?

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The Clagett procedure and Eloessar flap are both rarely performed surgical procedures used to control a chronic empyema that has failed to resolve with first line procedures such as thoracoscopic or thoracotomy drainage and decortication; particularly in fragile patients unlikely to tolerate an extensive decortication.

The Clagett prcedure is a three stage procedure whereby lower posterolateral ribs are ressected and an open window to the empyema is created to allow drainage. It is packed and irrigated with appropriate antibiotics and may be closed later by secondary intention or operatively using an omental or vascularised muscle flap.

The Eloessar flap is a single stage procedure where again the lower posterolateral ribs are ressected, the skin flaps are sutured to the parietal pleura (“marsupialised”) and an open window to the empyema is created to allow drainage. Unlike the Clagett procedure, the Eloessar flap is permanent and not subsequently reversed.

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