الفهرس 
Patients and MethodsOnly 14 pages are availabe for public view
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Abstract
The standard posterolateral muscle-splitting incision remains the thoracic incision of choice of most thoracic surgeons and has withstood the test of time. This incision provides excellent exposure for almost any intrathoracic procedure, and the functional and cosmetic results are acceptable.
Postero-lateral thoracotomy has many complications such as postoperative pain, limitation in the motion of the shoulder, decreasing pulmonary function from immobilization, increasing lung atelectasis from over-use of analgesia, and increasing pulmonary morbidity, especially in elderly patients. So, muscle-sparing thoracotomy appears to be a good alternative. But it has also many disadvantages such as seroma and the needs for drains, limitation of an accessible operative field, and difficulties with risky procedures. We have modified muscle sparing vertical thoracotomy.
Our study was to compare two groups of patients who underwent thoracotomy incision. The study was carried on a total number of 30 patients. The patients were divided into two groups. Group A consisted of 15 patients who underwent vertical thoracotomy incisin. Group B consisted of 15 patients who underwent posterolateral thoracotomy.
Our experience has been that wound healing of a vertical axillary incision is excellent despite the fact that the incision passes perpendicular through Langer’s line.
The cosmetic outcome is impressive because the vertical incision is masked by the upper arm. Seromas occasionally develop, which require no treatment. These are avoided to a greater extent than is possible with the transverse incision because the skin and subcutaneous tissue do not need to be elevated as a separate layer , which also eliminates the need for subcutaneous drain.
Vertical axillary thoracotomy offers the specific advantages of minimum trauma and maximum preservation of chest wall function. A
cosmetically acceptable scar results. The vertical axillary thoracotomy is specifically indicated in patients requiring less than the maximum intrathoracic exposure provided by the more traumatic posterolateral or anterolateral thoracotomy.
The vertical axillary thoracotomy provides adequate exposure for a wide variety of surgical procedures. Its limitation consists of restricted access to the posterior costophrenic angle. Dividing the anterior serratus vertically while preserving the nerve supply, then retracting it posteriorly with the latissimus dorsi and the scapula gives adequate access to the ribcage, thus avoiding major injury to the chest wall.
Results that emerged from our study comparing our experience with vertical thoracotomy with the standard posterolateral thoracotomy are:
(1) Vertical muscle sparing thoracotomy can be used for a wide range of procedures in different age groups of both sex .
(2) Exposure is better with standard posterolateral thoracotomy than that with vertical muscle sparing thoracotomy and the duration of surgery is slightly more with no statistical significant difference between both groups as regard intraoperative complications.
(3) There was no statistical difference between both group in the post-operative and wound complications . Seroma was more with muscle sparing but required no treatment .
(4) There was a significant statistical difference between the two groups regarding time of opening but closure required less time than that of muscle splitting thoracotomy.
(5) There was a significant statistical difference between the two groups regarding movement of the shoulder joint and shoulder girdle strength is significantly better when vertical muscle sparing was used than the standard posterolateral thoracotomy.
(6) The cosmotic results are better with vertical thoracotomy as the scar has been obscured by the arm .
Results during follow-up, along with others published by many authors, seem to be encouraging, and push up to keep on performing the technique of vertical thoracotomy.