Transmanubrial Osteomuscular Sparing Approach for Apical Chest Tumors

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Abstract

The transclavicular approach improved the treatment of apical chest tumors. However, removing the internal half of the clavicle and sectioning its muscular insertions led to serious postoperative alterations. We propose a transmanubrial approach, through a manubrial L-shaped transection and first costal cartilage resection, which allows retraction of an osteomuscular flap including but sparing the clavicle and all its muscular insertions. The elevation of the osteomuscular flap affords excellent access to the subclavicular region with safe control and resection of neurovascular outlet structures during the resection of apical chest tumors. Shoulder articulations and stability of the scapular girdle are respected, thus avoiding functional and cosmetic consequences of clavicle resection.

(Ann Thorac Surg 1997;63:563–6)

Section snippets

Technique

The skin incision is performed through an L-shaped cervicotomy with the upper line on anterior part of sternomastoid as far as the angle of manubrium and two fingers below the clavicle (Fig. 1). The sternomastoid muscle is dissected along its anterior part from cervical tissue up to internal jugular vein, the major pectoral muscle is spared, and the sternal manubrium is exposed (Fig. 2). The internal thoracic artery is divided and 25% of the superoexternal part of the manubrium (2 by 2 cm) is

Comment

At present, different anterior approaches for apical chest tumors have been proposed; ATA, proximal extended median sternotomy, and hemi-clamshell approaches have advantages and disadvantages, and all are worthwhile. Extended cervicosternothoracotomy, described by Masaoka and colleagues [[3]], and the hemi-clamshell technique described by Bains and colleagues [[4]] have some disadvantages. First, it is a difficult posterior dissection in the case of chest wall and vertebral invasion, and

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