Background Function of the thoracic sympathetic chain (TSC) reportedly recovers after surgical clips are removed. Hence, this study was designed to study nerve regeneration after unclipping the TSC. Methods The bilateral TSCs of six goats were studied; the goats were separated into three groups (groups I, II, and III) during excision, clipping, and unclipping. During surgery, the TSCs were excised with a scalpel in group I and clipped in groups II and III. In group III, the clips were removed 1 month postoperatively and observed for possible nerve healing for 1 month. All TSCs were examined histologically following en block resection at 1 month postoperatively in groups I and II and at 2 months postoperatively in group III. Results Inflammation in nerve sections was noted following clip removal. Furthermore, there was significant degeneration and cell infiltration in the nerve fibers of the clipped regions. The Schwann cells around the peripheral nerve endings in the unclipped regions facilitated nerve transmission by reconstitution of myelin. Conclusion Clipping the TSC can cause histologic degeneration; however, histologic nerve regeneration occurs after unclipping.

Background/Objectives: Managing postoperative drainage and reducing the length of hospital stays continue to represent significant challenges in thoracic surgery. While systemic antifibrinolytics are effective, concerns persist regarding neurotoxicity and thromboembolic risks. In this study, we evaluated the efficacy and safety of a unique, high-volume topical tranexamic acid (t-TXA) lavage protocol designed to optimize pleuroparenchymal contact and stabilize local hyperfibrinolysis. Methods: A retrospective comparative study was conducted involving 52 patients undergoing major lung resection, divided into a t-TXA group (n = 26) and a control group (n = 26). The t-TXA group received an intrathoracic lavage consisting of 5 g of tranexamic acid (TXA) diluted in 500 mL of saline, while the control group received 500 mL of saline alone. The primary outcomes included postoperative day (POD) 1 drainage volumes and length of stay (LOS). The secondary outcomes were focused on hematological parameters and safety profiles, including a structured one-year follow-up for all patients. Due to the study’s exploratory nature, primary outcomes were assessed using 95% confidence intervals for hypothesis generation rather than a priori sample size calculations. Results: No significant differences were observed between groups regarding sex, surgical approach, or resection type. The t-TXA group demonstrated a significantly shorter LOS (4.20 ± 1.23 days) compared to the control group (5.88 ± 2.23 days; p = 0.001). While POD 1 drainage was numerically lower in the t-TXA group (189.23 ± 235.06 mL) versus the control (284.23 ± 169.40 mL), this difference did not reach statistical significance (p = 0.101). However, exploratory correlation analysis revealed a moderate negative association between t-TXA application and POD 1 drainage (r = −0.412; p = 0.002). Postoperative platelet counts were significantly lower in the t-TXA group (p = 0.009). No thromboembolic events, late complications, or deaths occurred in either group during the one-year follow-up period. Conclusions: High-volume t-TXA lavage is a promising adjuvant associated with significantly shorter hospital stays and a trend toward reduced postoperative drainage. While our 12-month follow-up confirmed a favorable safety profile with no adverse events, these findings should be interpreted as preliminary and hypothesis-generating. The retrospective nature of this study precludes definitive recommendations, underscoring the need for well-powered prospective randomized trials to establish the long-term safety and clinical utility of t-TXA in thoracic surgery.