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Exposures for Chest Trauma: The Median Sternotomy and Left Anterolateral Thoracotomy | Basicmedical Key

Exposures for Chest Trauma: The Median Sternotomy and Left Anterolateral Thoracotomy


Fig. 2.1

Left anterolateral thoracotomy incision




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Fig. 2.2

Manual compression of the aorta



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Fig. 2.3

Clamping the aorta



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Fig. 2.4

Opening the pericardium



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Fig. 2.5

Cardiac massage—notice two hands



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Fig. 2.6

Clamshell thoracotomy


Pitfalls






  • The incision does not follow the intercostal space, making the entry into the chest difficult. Incision should curve upward towards the axilla



  • Excessive rib spreading may cause rib fractures and increased pain in the postoperative course.



  • The retractor may cause injury to the internal mammary artery, leading to subsequent bleeding.


Indications for Median Sternotomy


This is the preferred incision for penetrating injuries to the anterior chest, allowing exposure of the heart, lungs, middle-to-distal trachea, and the left main bronchus.


This does not allow exposure to the posterior mediastinal structures and does not provide the ability to cross clamp the aorta for resuscitation purposes. The median sternotomy allows exposure to the upper mediastinal vessels and can be extended on to the neck with a sternocleidomastoid incision or a clavicular incision to allow more exposure to the carotid or subclavian vessels.


Operative Technique for Median Sternotomy




Oct 20, 2020 | Posted by in GENERAL SURGERY | Comments Off on Exposures for Chest Trauma: The Median Sternotomy and Left Anterolateral Thoracotomy
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