Cardiothoracic Incisions Flashcards
What incisions are usually done in cardiothoracic surgery?
Median sternotomy
Thoractomy
Pacemaker incision
What is the most common thoracic incision?
Median sternotomy
Used for open heart surgery, valve replacements, CABG or cardiac transplants
Explain median sternotomy
Incision is made from the substernal notch to around the xiphoid process
You then cut directly through the sternum to enter the thoracic cavity.
This can cause significant scar formation and chronic chest pain
Explain pacemaker incision
4-5 cm incision made in the left infraclavicular region
Horizontal, oblique and deltopectoral incisions might be used.
A subcut pocket is created for the pacemaker to be implanted to.
What are thoracotomy incisions used for?
To access the pleural space of the thorax
What are the three main subtypes of thoracotomy?
Posterolateral incision
Anterolateral incision
Axillary incision
Explain posterolateral incision
The gold standard for access to thorax
Provides access to all the thoracic viscera and can be used for pulmonary resections, chest wall resections or oesophageal surgery.
Explain the posterolateral incision method.
Patient is in a lateral decubitus position.
You start from the between the scapula and mid-spinal line and extends laterally to the anterior axillary line.
You pass through the lats, serratus anterior muscles and transect rhomboids and trapezius.
Explain anterolateral incision
Used in cardiac, pulmonary and oesophageal pathology
The incision runs from the lateral border of the sternum to the mid axillary line at 4th or 5th intercostal space
This is through the pec major and serratus anterior.
Explain axillary incision.
Muscle sparing approach for pneumonectomy and pneumothorax operations.
Incision is made between posterior border of pec major and anterior border of lats dorsi through 4th and 5th intercostal space.
It reduces muscle damage and a has better cosmetic outcome.
