Thoracic incision
Definition
A thoracotomy is an incision into the thoracic cavity to gain access to the lungs, bronchi, heart or esophagus.
Types
1)LATERAL INCISION
a) posterolateral incision
b) anterolateral incision
2)ANTERIOR INCISION
a) transverse incision
b)Vertical incision
c) thoracolapromy incision
1) LATERAL INCISION
A) POSTEROLATERAL INCISION
Extent:
From the vertebral border of scapula at the level of T3 vertebra through the line of 5th,6th,7th and 8th ribs to the anterior angle or costal margin.
.
Muscle cut:
-trapezius
-latissimus dorsi
-rhomboids
-serratous anterior
-intercostal muscle
-erector spinae
A rib may be removed so that the other ribs can be restricted for easy access to the thoracic.
Indication;
Mainly for lung operation
-pneumonectomy
-lobectomy
-segmental resection
-wedge resection
-lung volume reduction surgery
B) ANTEROLATERAL INCISION.
EXTENT:
It starts from 1-2 inches lateral to the sternum at the sternum at the level of 5th costal cartilage (just below the nipple) and through the 5th ,6th 7th rib up to the posterior axillary line.
Muscle cut
-pectoralis major and minor
-serratous anterior
-intercostal muscle
Indication
Cardiac surgeries like mitral valvotomy
Pleurectomy
2)ANTERIOR INCISIONS
A)TRANSVERSE INCISION (sub mammary)
Extent
From one side of 4th intercostal space to other
muscle divided:
-pectoralis major
-internal and external intercostals muscle
-sternum is divided transversely
B) VERTICAL INCISION ( median or midline sternotomy or sternal split)
Extent
from just above suprasternal notch to a point about 3 cm below the xiphi sternum
No muscles are cut except for aponeurosis of pectoralis major
Indication
1)open heart surgery
– valve repair and replacement
-ASD
-VSD
-Fallot’s teratology
-CABG’s
-Heart transplantation
2)Lung volume reduction surgery
3) bilateral pleurectomy
c) THORACLAPROTOMY
Extent
Along the curve of 7th or 8th rib and extends up to the umbilicus
Muscle cut:
-latissimus dorsi
– serratus anterior
– intercostalis
– abdominal muscle
Indications:
Surgeries of lower esophagus and stomach
Note:- lateral costal incision are used for closed heart surgery while vertical incision is used for open heart surgery.
