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Eur J Cardiothorac Surg 2007;32:551-552. doi:10.1016/j.ejcts.2007.06.002
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Letters to the Editor

Reply to Shipkov et al.

Kalliopi Athanassiadi*

1st Department of Thoracic Surgery, General Hospital for Chest Diseases, Athens, Greece

Received 30 May 2007; accepted 4 June 2007.

* Corresponding author. Address: Konstantinoupoleos Str. 34A, Holargos, 15562 Athens, Greece. Tel.: +30 210 6510388; fax: +30 210 6547695. (Email: kallatha{at}otenet.gr).

Key Words: Thoracotomy • Posterolateral • Muscle sparing • Latissimus dorsi

We would like to thank Dr Shipkov and co-authors [1] for sharing their experience and comments with us.

Actually, we do not find that one shall divide the latissimus dorsi and serratus anterior muscles in posterolateral thoracotomy (PLT) in order to gain exposure. Even with muscle-sparing thoracotomy (MST) in cases of lung surgery, one can have almost the same exposure if the muscles are correctly dissected. The preservation of major thoracic muscles is important for the stabilization and rotation of the scapula, although the difference between the two different approaches was not found to be statistically significant in our study [2].

At last, the preservation of blood supply of both above-mentioned muscles makes it easier for thoracic surgeons to use muscle transposition in cases of postresectional space problems or in cases of thoracic wall reconstruction [3].

It is a fact that even after PLT the latissimus dorsi muscle still retains some reconstructive potential [4]. The thoracodorsal artery, a branch of the subscapular artery, is the dominant vessel entering the proximal part of the muscle approximately 10 cm from its origin. The muscle is also nourished by segmental perforating vessels coming from the intercostal and lumbar arteries [5]. Both the proximal and the distal parts of the muscle can be used, although there is of course a certain degree of atrophy of the distal portion after division of the muscle.

We strongly insist that a reconstruction after PLT should be an interdisciplinary procedure involving both plastic and thoracic surgeons, especially in the use of the latissimus dorsi flap pedicled on segmental perforating vessels.

References

  1. Shipkov C, Mojallal A, Uchicov A. The importance of muscle sparing thoracotomy for the treatment of post resectional complications after thoracotomy 2007;32(3):551.
  2. Ginsberg RJ, Shipkov CD, Mojallal A, Uchikov A. Alternative (muscle sparing) incisions in thoracic surgery. The importance of muscle-sparing thoracotomy for the treatment of postresectional complications after thoracotomy. Ann Thorac Surg 1993;56(3):752-754.[Abstract]
  3. Athanassiadi K, Kakaris S, Theakos N, Skottis I. Muscle-sparing versus posterolateral thoracotomy: a prospective study. Eur J Cardiothorac Surg 2007;31:496-500.[Abstract/Free Full Text]
  4. Koch H, Tomaselli F, Pierer G, Schwarzl F, Haas F, Smolle-Jüttner FM, Scharnagl E. Thoracic wall reconstruction using both portions of the latissimus dorsi previously divided in the course of posterolateral thoracotomy. Eur J Cardiothorac Surg 2002;21:874-878.[Abstract/Free Full Text]
  5. Cohen M. Reconstruction of the chest wall. In: Cohen M, editor. Mastery of plastic and reconstructive surgery. Boston, MA: Little, Brown; 1994. pp. 1248-1275.




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