Skeletonization and harvest of the internal thoracic artery with an ultrasonic scalpel Tetsuya Higami, MD, Syuichi Kozawa, MD, Tatsuro Asada, MD, Tsutomu.

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Skeletonization and harvest of the internal thoracic artery with an ultrasonic scalpel Tetsuya Higami, MD, Syuichi Kozawa, MD, Tatsuro Asada, MD, Tsutomu Shida, MD, Kyoichi Ogawa, MD The Annals of Thoracic Surgery Volume 70, Issue 1, Pages 307-308 (July 2000) DOI: 10.1016/S0003-4975(00)01436-3

Fig 1 (A) The endothoracic fascia is incised longitudinally just medial to one of the satellite veins using the Harmonic Scalpel. The space between the medial satellite vein and the internal thoracic artery (ITA) is carefully dissected. (B) The endothoracic fascia is pulled back carefully, thus exposing the sternal branch. The tip of the blade is placed on the branch at least 1 mm from the trunk. The branch is obstructed and divided by ultrasonic protein coagulation. (C) Pulling the fascia down, exposes the perforating cutaneous branch on the back side of the vessel for treatment. (D) Turning the ITA 90 degrees exposes the anterior intercostal branch. Thus it is possible to treat all of the branches from the same angle with the same field of view. The Annals of Thoracic Surgery 2000 70, 307-308DOI: (10.1016/S0003-4975(00)01436-3)