title: Technical aspects in skeletonization of the internal thoracic artery using an ultrasonic scalpel.
abstract: OBJECTIVE
  To describe the technique and evaluate the immediate results of using an ultrasonic scalpel in the skeletonization of the internal thoracic artery for coronary artery bypass grafting surgery.
  
  
  METHODS
  From January 2000 to October 2006, 188 patients were submitted to coronary artery bypass grafting with the internal thoracic artery skeletonized using an ultrasonic scalpel. Seventy-one patients (37.8%) were women. The patients' ages varied from 28 to 81 years old. The entire internal thoracic artery was exposed opening the endothoracic fascia using scissors as close as possible to the arterial adventitia. An ultrasonic scalpel was used to transect and coagulate all the intercostal branches, thereby minimizing the use of metallic clips.
  
  
  RESULTS
  The skeletonized internal thoracic arteries presented with excellent flow, obviating the need for intraluminal manipulation for vasodilatation. In the immediate postoperative period, two patients were found to have temporary left-sided diaphragmatic paralysis. There were no sternal wound infections in this series. The dissection can be performed in approximately 33 minutes however with more experience this time may be reduced.
  
  
  CONCLUSIONS
  This technique facilitates and shortens the internal thoracic artery skeletonization procedure and does not cause arterial spasms. Cauterization of the collateral branches with an ultrasonic scalpel is efficient and the use of metallic clips is almost unnecessary. It is a procedure that is easy to reproduce and may be recommended as the first-choice technique for the dissection of the internal thoracic artery.
authors.affiliation: Hospital Jaime da Fonte (HJF), Recife, PE. alexmottamenezes@yahoo.com.br
authors.forename: Alexandre Motta de
authors.initials: AM
authors.lastname: Menezes
authors.forename: Frederico Pires de
authors.initials: FP
authors.lastname: Vasconcelos
authors.forename: Ricardo de Carvalho
authors.initials: Rde C
authors.lastname: Lima
authors.forename: Mário Gesteira
authors.initials: MG
authors.lastname: Costa
authors.forename: Mozart Augusto Soares de
authors.initials: MA
authors.lastname: Escobar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001795:Blood Pressure Determination; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D004210:Dissection / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000637:transplantation*; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care; D020858:Tissue and Organ Harvesting / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency