Anterolateral thoracotomy

The incision begins 4 fingerbreadths below the nipple in the midclavicular line and runs along the submammary fold.

Note: In women, it is important when making the incision to avoid cosmetic disadvantages to the breast.

The incision is then extended obliquely to the posterior axillary line, to a point 2 fingerbreadths above the tip of the scapula.

Note: Depending on requirements, the incision may be extended as far as the sternum. In posterolateral thoracotomy, the incision is continued around the tip of the scapula to about 4 fingerbreadths lateral to the spinous processes of the vertebral column.

The subcutaneous fatty tissue is then divided with diathermy until the muscle is reached.

Next, the serratus anterior muscle is divided down to the ribs while sparing the latissimus dorsi muscle, which is retracted posteriorly with a hook.

Note: To avoid blood loss, the chest wall muscle is divided routinely using diathermy.