The utility of muscle sparing axillar skin crease incision for pediatric thoracic surgery.
BACKGROUND
Posterolateral or standard axillar incisions for the pediatric thoracic surgery are occasionally associated with poor motor as well as cosmetic results, including chest deformities and large surgical scars. A muscle sparing axillar skin crease incision (MSASCI) was initially proposed by Bianchi et al. (in J Pediatr Surg  33:1798-1800, 1998) followed by Kalman and Verebely (in Eur J Pediatr Surg 12:226-229, 2002) resulting in satisfactory cosmetics. However, they performed operations through the third or fourth intercostals space (ICS), therefore the target organs were restricted in the upper two-thirds of the thoracic cavity.


METHODS
Thoracic surgeries were performed using MSASCI in 27 patients (1-day to 9-year old). There were ten patients with esophageal atresia, seven with congenital cystic adenomatoid malformation, five with pulmonary sequestration, two with mediastinal neuroblastoma, two with right diaphragmatic hernia, and one with pulmonary hypertension. A thoracotomy was performed through the appropriate ICS (from third to eighth).


RESULTS
In all patients, the expected procedures, including pulmonary lower lobectomy, were successfully performed by MSASCI throughout the thoracic cavity. A good operational field was easily obtained in neonates and infants. Most of the patients achieved excellent motor and aesthetic outcomes.


CONCLUSIONS
MSASCI may become the standard approach for the thoracic surgery for small children.
Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. taguchi@pedsurg.med.kyushu-u.ac.jp
Tomoaki
T
Taguchi
Kouji
K
Nagata
Yoshiaki
Y
Kinoshita
Satoshi
S
Ieiri
Tatsuro
T
Tajiri
Risa
R
Teshiba
Genshiro
G
Esumi
Yuji
Y
Karashima
Sumio
S
Hoka
Kouji
K
Masumoto
D001365:Axilla; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000601:surgery*; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007366:Intercostal Muscles / Q000601:surgery*; D008297:Male; D010369:Pectoralis Muscles / Q000601:surgery*; D013536:Suture Techniques; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome