Transthoracic Forequarter Amputation and Left Pneumonectomy

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Presentation transcript:

Transthoracic Forequarter Amputation and Left Pneumonectomy Aroldo Fianchini, Aldo Bertani, Franco Greco, Alessandro Brunelli, Mauro Muti The Annals of Thoracic Surgery Volume 62, Issue 6, Pages 1841-1843 (December 1996) DOI: 10.1016/S0003-4975(96)00501-2

Fig. 1 With the patient supine and the left shoulder lifted up to 30 degrees to the operating table, the incision begins at the sternoclavicular junction and runs laterally over the deltopectoral groove to reach the deltoid region, where it designs a deltoid-humeral flap. Medially, it is carried out over the sternum down to the xiphoid, where it curves laterally to perform an anterior thoracotomy at the seventh intercostal space. The Annals of Thoracic Surgery 1996 62, 1841-1843DOI: (10.1016/S0003-4975(96)00501-2)

Fig. 2 Sternoclavicular disarticulation and division of the subclavian artery distal to the take-off of the vertebral artery are performed. The subclavian vein and the cords of the brachial plexus are similarly divided. Humerus disarticulation and resection of the glenoid, coracoid, and acromion are performed. Ribs 1 through 7 are disarticulated from the sternum, and the hilar structures of the left lung are prepared. The Annals of Thoracic Surgery 1996 62, 1841-1843DOI: (10.1016/S0003-4975(96)00501-2)

Fig. 3 The pulmonary vessels and main bronchus are stapled and divided. Next, after ligation of the intercostal bundles, ribs 1 through 7 are resected at the level of the costotransversarian juncture, the incision is completed posteriorly, and the left forequarter is removed en bloc with the thoracic wall and the lung. The scapula is freed from its lateral muscular attachments to provide mobilization. The Annals of Thoracic Surgery 1996 62, 1841-1843DOI: (10.1016/S0003-4975(96)00501-2)

Fig. 4 The eight and ninth ribs are resected anteriorly, fractured posteriorly with their bundles left intact, rotated, and anchored to the sternum to protect the tip of the heart. The scapula is rotated anteriorly and medially to protect the aortic arch and the hilum. The Annals of Thoracic Surgery 1996 62, 1841-1843DOI: (10.1016/S0003-4975(96)00501-2)

Fig. 5 A contralateral pectoral flap and homolateral deltoid and lateral lumbar flaps are advanced to close the defect. The Annals of Thoracic Surgery 1996 62, 1841-1843DOI: (10.1016/S0003-4975(96)00501-2)