TRANSMANUBRIAL OSTEOMUSCULAR SPARING APPROACH FOR APICAL CHEST TUMORS

The transclavicular approach improved the treatment of apical chest tu mors. However, removing the internal half of the clavicle and sectioni ng its muscular insertions led to serious postoperative alterations. W e propose a transmanubrial approach, through a manubrial L-shaped tran section and first costal cartilage resection, which allows retraction of an osteomuscular flap including but sparing the clavicle and all it s muscular insertions. The elevation of the osteomuscular nap affords excellent access to the subclavicular region with safe control and res ection of neurovascular outlet structures during the resection of apic al chest tumors. Shoulder articulations and stability of the scapular girdle are respected, thus avoiding functional and cosmetic consequenc es of clavicle resection. (C) 1997 by The Society of Thoracic Surgeons .