Anatomical bases of lateral thoracotomy without muscle transection

Richelme, H; Limouse, B; Ferrari, Cecilia; Bourgeon, A

doi:10.1007/bf01773159

Cited by 5 publications

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“…The fifth ICS, together with the sixth ICS, is the most extensive region among others, gives a balanced view for various surgeries, and is commonly used as a reference site for posterolateral thoracotomy (Richelme et al, 1984). However, based on the results of this study, the LTN crosses the MAL in the fifth ICS by 25%, and the LTN branches located in the aMAL by 20%.…”

Section: Discussionmentioning

confidence: 99%

“…Thoracotomy is a procedure of opening the thoracic wall for chest surgeries, and during posterolateral thoracotomy, the most common approach, surgeons perform incision within the fourth to the sixth intercostal space (ICS) (Bal, Elshershari, Celiker, & Celiker, 2003; Nguyen & Nguyen, 1987; Richelme, Limouse, Ferrari, & Bourgeon, 1984), so the LTN that passes through this area could be injured during the procedure (Lagueny, Reboul, Kien, & Duché, 2014). In Bal et al's (2003) study, 77% of pediatric patients who had undergone surgery for congenital cardiac disease showed scapular winging induced by LTN injury.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of the positional relationship of the long thoracic nerve considering clinical treatment

et al. 2020

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Introduction The long thoracic nerve (LTN) has a risk of being damaged during chest surgery and should be considered when performing anesthesia such as a serratus anterior plane block (SAPB). We analyzed the relationship between landmarks—the fourth to ninth intercostal space (ICS) at the midaxillary line (MAL), through which the distal part of the LTN passes—and the LTN. Materials and methods We used 25 specimens from 17 embalmed Korean cadavers. The MAL, level of rib and ICS, and regions 5 cm anteroposterior to the MAL (aMAL/pMAL) were established to measure the position of the LTN crossing the MAL, pathway of the LTN, and entering points of the LTN to the SA. Results The LTN crossed the MAL in 76% of the specimens. The LTN crossed the MAL within the fifth to sixth rib level in 70.8%. Seventy‐six percent of the branches entered the SA within the fourth to sixth ICS. The fifth rib and ICS were the most frequent regions aMAL; however, several branches were found pMAL. The LTN entered the SA in 92.6% of the specimens within 3 cm anterior and 1 cm posterior to the MAL. Conclusions We set the danger zone as 4 cm near the MAL at the fourth to sixth ICS for thoracotomy. In addition, we proposed the fifth ICS in aMAL at the superficial plane as the alternative injection point for SAPB when blocking the LTN, and the fifth ICS in pMAL at the deep plane to prevent blocking the LTN.

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Section: Discussionmentioning

confidence: 99%