Mattox Maneuver: Definition, History, Technique, Indications, Complications, Modified Mattox Maneuver vs Thoracotomy

Mattox Maneuver:

• What is Mattox Maneuver?
• Mattox Maneuver History
• Mattox Maneuver Technique
• Mattox Maneuver Indications
• Mattox Maneuver Complications
• Modified Mattox Maneuver vs Thoracotomy

What is Mattox Maneuver?

The Mattox Maneuver is a surgical exposure technique primarily used in trauma surgery to gain rapid access to the abdominal aorta and other retroperitoneal structures. It involves a left-sided medial visceral rotation, where the left colon, spleen, kidney, pancreas, and sometimes part of the stomach are mobilized medially to expose the abdominal aorta from the diaphragm to the bifurcation.

This maneuver is life-saving in cases of severe abdominal trauma, vascular injury, or massive hemorrhage when rapid control of bleeding is necessary. It is a cornerstone procedure for trauma surgeons, offering a systematic and reliable method of accessing difficult-to-reach areas of the retroperitoneum.

Mattox Maneuver History

The technique is named after Dr. Kenneth L. Mattox, a renowned trauma surgeon who contributed extensively to the field of emergency and trauma surgery. He popularized this maneuver as part of advanced trauma surgical management strategies. Over the years, it has become a vital skill taught in trauma surgery training.

Historically, gaining access to the retroperitoneum during trauma was extremely challenging. The development and adoption of the Mattox Maneuver provided surgeons with a structured approach that improved patient survival in complex abdominal injuries.

Mattox Maneuver Technique

The surgical technique begins with a midline laparotomy. The surgeon incises the lateral peritoneal attachments of the descending colon, mobilizes the left colon medially, and continues to free the spleen, pancreas tail, and left kidney. This creates a “visceral rotation,” exposing the abdominal aorta and associated vessels.

The dissection must be meticulous to avoid injury to the spleen or kidney. Once completed, the surgeon has wide exposure to the abdominal aorta, left renal vessels, and other retroperitoneal structures, allowing for vascular control and repair of traumatic injuries.

Mattox Maneuver Indications

The primary indication for performing the Mattox Maneuver is trauma surgery requiring rapid access to the abdominal aorta or retroperitoneal space. Common situations include penetrating or blunt abdominal trauma with uncontrolled bleeding, suspected major vessel injury, and retroperitoneal hematomas.

It is also indicated in certain elective vascular surgeries when full visualization of the abdominal aorta is required, such as in aortic aneurysm repair. In emergencies, its timely use can mean the difference between life and death.

Mattox Maneuver Complications

Like any major surgical maneuver, complications may occur. Potential risks include injury to the spleen, pancreas, kidney, or bowel during mobilization. Excessive bleeding can result from inadvertent vascular injury, while postoperative risks include infection, abscess formation, or prolonged ileus.

Despite these risks, in life-threatening trauma situations, the benefits of performing the maneuver generally outweigh the potential complications. Surgeons must balance speed with precision to avoid worsening the patient’s condition.

Modified Mattox Maneuver vs Thoracotomy

The Modified Mattox Maneuver is a variation that may involve partial mobilization of the left-sided viscera without full medial rotation, depending on the exposure needed. It allows selective access in cases where complete mobilization is not required, potentially reducing operative time and risk of organ injury.

In contrast, a thoracotomy is a chest-opening procedure often used in cases of thoracic trauma or cardiac arrest from penetrating injuries. While the Mattox Maneuver provides access to abdominal vascular structures, a thoracotomy offers direct entry into the chest cavity. Choosing between these procedures depends on the injury location and urgency. Both techniques remain critical life-saving strategies in trauma surgery.