Anatomical study of the thorax for the safe performance of the Nuss procedure for pectus excavatum.
BACKGROUND
To perform a minimally invasive repair for pectus excavatum safely, accurate knowledge of the anatomy of the retrosternal region is crucial. This study was carried out to provide more information on this region.


METHODS
1. Using 32 human cadavers, the vascular structure in the retrosternal region was studied. 2. The pleura, transverse thoracic ligament, pericardium, and diaphragm were taken from 10 fresh cadavers, and their thicknesses and breaking strengths were measured.


RESULTS
Thick vessels connecting the internal mammary vessels and anterosuperior phrenic vessels were present in a certain number of cadavers. This presence of a vascular communication was observed in 44 % of left thoracic cavities and 12.5 % of right thoracic cavities. The breaking strengths of the pericardium and diaphragm were found to be nearly ten times greater than that of the pleura.


CONCLUSIONS
Care should be taken not to injure vessels connecting the internal mammary vessels and anterosuperior phrenic vessels when performing retrosternal undermining of the xiphoid region. Since the pericardium is much thicker than the pleura, injury of the pericardium can be avoided by careful undermining.
Plastic and Reconstructive Surgery, Keio University Hospital, Tokyo, Japan. nagasao@sc.itc.keio.ac.jp
T
T
Nagasao
M
M
Takayama
J
J
Miyamoto
W
W
Ding
H
H
Jiang
D002102:Cadaver; D005660:Funnel Chest / Q000473:pathology / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D019637:Orthopedic Procedures / Q000379:methods*; D035441:Thoracic Wall / Q000002:abnormalities* / Q000601:surgery*; D013906:Thoracoscopy; D013909:Thorax / Q000473:pathology*; D016896:Treatment Outcome