ACCESS TO THE THORAX BY INCISION

BACKGROUND: For years the standard access to the thorax has been by po sterolateral or other muscle cutting thoracotomy incisions. These are accompanied by significant discomfort and often limitation of shoulder girdle movement. To obviate these distressing features, the less trau matic median sternotomy was recommended. In the last ten years, severa l types of mini or axillary thoracotomies have been described. We beli eve that the vertical axillary thoracotomy is the best of these incisi ons as no major muscles are divided, it can be created rapidly, and ex posure is excellent. STUDY DESIGN: We compared the operative approache s from the point of view of the duration of postoperative hospitalizat ion, the length of the operating time, the incidence of postoperative atelectasis, and persistence of incisional pain. RESULTS: The vertical axillary thoracotomy showed a definite advantage in all these categor ies. CONCLUSIONS: These findings suggest that the vertical axillary th oracotomy is the incision of choice for most thoracic procedures as th e incision is small and quickly made. Because there is limited divisio n of muscles, the convalescence is smooth and uncomplicated.