OrthoNet

Thoracic spine - anterior approach

* position - lat. with bean bag

* incision
- usu R sided approach
- 1/2way btw spine & scapula –> ant. axillary line
- 2 ribs above level wanting to be accessed

* dissection
- divide lat. dorsi in line with skin
- divide serratus ant. in line with skin down to rib
- expose rib subperiosteally
- resect rib as far post. as possible
- nick pleura with knife
- enter pleura bluntly
- deflate lung & retract ant.
- identify esphagus
- incise pleura over lat. sid of esophagus & retract
- tie off intercostal vessels (avoid if possible due to blood supply to SC)

* dangers
- intercostal vessels
> during rib resection
> during exposure of vert. body
- lung