Thorax

Question 1

What are the two types of incisions in the anterolateral approach to the thorax?

Answer 1

French incision- axilla to nipple

Muscle sparing- in triangle of safety between pec maj and lat dorsi

Question 2

What is the anterolateral approach used for?

Answer 2

Upper lobe exposure and bullectomy with adhesions

Question 3

What is the set up for the posterolateral approach?

Answer 3

GA, lateral decubitus, knee and hip flexed, arms praying position with superior arm support, pressure point padding, sandbag support at ipsiL hip and knee, avoid superior arm overhanging the chest and limiting access to thoracic cavity

Question 4

Incision for posterolateral approach?

Answer 4

2cm below tip of scapula to halfway between medial boarder of scapula and spinous processes curving up to follow ribs

Question 5

What are the layers encountered in a posterolateral thoracotomy

Answer 5

Skin, fat
latissimus dorsi- divide
serratus ant.- spread
intercostal muscles- divide

Question 6

layers of intercostal muscles?

Answer 6

standard- external, internal, innermost
anteriorly- subcostalis
laterally- transversus thoracalis

Question 7

Which muscle if not sewn back correctly can give a dog ear deformity?

Answer 7

Larissimus dorsi

Question 8

Set up for median sternotomy

Answer 8

GA, supine, inspect, palpate- sternal click, ausculatate, percuss

Question 9

Incision?

Answer 9

Sternal notch to xiphisternum

Question 10

How do you cut the sternum?

Answer 10

jiggly saw- transplant runs
oscilating saw- first time
reciprocating saw second onwards
Xiphisternum- scissors

Question 11

Where is the intercostal vasculature in the ICS? and arrangement?

Answer 11

VAN- superior to inferior. In the intercostal groove at the bottom of the rib or the top of the space.
Collaterals are run in the inferior of the space

Question 12

First layer encountered in <20 year olds?

Answer 12

Thymus/ connective tissue in adults

Question 13

What incision into the pericardium. What to watch out for?

Answer 13

Inverse T shaped incision, watch out for left phrenic which is more superior and medial than the right

Question 14

Coronry arteries and divisions?

Answer 14

Left coronary
LAD- diagonal
LCX- Marginal

Right coronary
Marginals

Posterior descending- mostly of Right- dominance

Question 15

Parts of the parietal pleura

Answer 15

mediastinal, diaphragmatic, costal

Question 16

Divisions of the Internal thoracic artery?

Answer 16

Superior epigastric artery

Musculophrenic artery

Question 17

Divisions of the ascending aorta?

Answer 17

Brachiocephalic trunk
Left common carotid
Left subclevian

Question 18

Which muscle in the neck does the phrenic nerve run over?

Answer 18

anterior scalene

Question 19

Where does the vagus nerve run in the neck?

Answer 19

Common carotid sheath