1. Versatility of a Mini-Trapdoor Incision in Upper Mediastinal Exposure
Phillip S. Ge, BA, Taryne A. Imai, MD, Timothy L. Van Natta, MD 
The Annals of Thoracic Surgery 
Volume 91, Issue 3, Pages (March 2011)
DOI: /j.athoracsur
Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Artist's depiction of the mini-trapdoor technique: (A) An incision is made from above the sternal notch to the lower manubrium, then laterally 2 fingerbreadths below the clavicle along the first intercostal space. (B) After division of the medial aspect of the pectoralis major, the superolateral manubrium is reflected laterally and stabilized with a self-retaining retractor. The brachiocephalic and subclavian vessels are thereby exposed. (IMA = internal mammary artery; IMV = internal mammary vein.) (C) An enlarged lymph node is shown overlying the subclavian vein. (D) Upon completion of the procedure, the manubrium is reapproximated with sternal wires, and overlying soft tissues are closed with absorbable sutures.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Imaging studies for patients 2–5. (A) Patient 2: angiogram shows subclavian artery injury. (B) Patient 3: a computed tomography scan shows infection involving the superomedial right ribs. (C) Patient 4: a computed tomography scan reveals lymph node metastasis adjacent to subclavian vein. (D) Patient 5: a computed tomography scan showing Pancoast tumor subjacent to subclavian artery.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions