[Thoracotomy with muscle sparing]

Muscle sparing thoracotomy is suggested more frequently in recent literature. From March 1988 to February 1990, a muscle sparing technique was used in 77 (58%) of 132 consecutive thoracotomies. There were 50 men and 27 women, age varied from 23 to 81 years, with a mean of 58 years. Forty-four lobectomies, 10 pneumonectomies, 9 lung biopsies, 6 wedge resections, 6 bullectomies and 2 segmentectomies were performed. A horizontal incision was used in 47 (61%) patients and a vertical mid-axillary incision in 30 (39%). For optimal exposure, transection of the latissimus dorsi muscle was needed in 14 (30%) of the horizontal incisions. Inadvertent rib fracture occurred in 10 (13%) cases. Continuous epidural analgesia was added in 46 (60%) patients for an average of 40 hours. Mechanical ventilation in 14 (18%) patients for a mean duration of 22 hours and an average stay of 2 days in the ICU and 7 days in the hospital, were required. There was 1 (1.3%) hospital mortality, 4 (5%) patients developed a seroma that required aspiration. Muscle sparing thoracotomy can be used safely for most thoracic procedures and we believe it permits easier pain control and early preservation of full shoulder motion. However the operative field is more restricted. A horizontal incision, permitting section of the latissimus dorsi for better exposure should be used for hilar or invasive lesions.