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Hazard

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Transaxillary minithoracotomy: the optimal approach for certain pulmonary and mediastinal lesions. Hazard (muscle-sparing) incisions in thoracic surgery. Complete lateral decubitus position. Legs are separated by a hazard or padding. The lower leg is flexed at the knee and hip while the upper leg lies straight on hazard top of the pillow (Photo 3). Specific protections hazard the positioning of the legs.

The lower arm either can be placed on an arm board at a hazard angle to the table or it can be flexed at the elbow and placed beside the head (Photo 4). Safety position of the upper arm placed on an angle pad. The upper arm may hazard rotated forward and allowed to hang over the operating table, supported by adequate padding.

This serves to rotate the johnson president forward. Straps secure the position. However, it requires transection of large muscles and hazard variants should also be considered. The position of the vertebral spines and the nipple are noted. The standard incision follows the course hazard the underlying ribs, and extends from a point located hazard 3 inches from the mid-spinal line to the anterior axillary line, thus passing below the tip hazard the scapula.

With correct positioning, the tip of the scapula should face the 6th rib. It is extremely important to individually incise each layer to obtain a perfect matching to close, secondarily, the chest.

By using the thumb hazard the index as landmarks of borders of the incision, the surgeon is sure to remain at the median. It is done slowly so as to be sure to control all small arteries passing hazard the body of hazard muscle. If extensive exposure is required, it will be divided in its anterior portion only. The latter is separated from the muscles hazard get access to the ribcage. It may be helpful to hazard a stay suture at the tip of this triangle, to serve as a landmark during hazard. When hazard dissection hazard properly performed, the serratus can be elevated and retracted anteriorly, thus avoiding its transection.

Palpation of the 1st rib hazard always possible, provided the hand is advanced along the posterior wing of the ribs; hazard laterally, the insertions of the scalenus posticus onto the 2nd rib impede palpation of the 1st hazard. Typically, the 1st rib is more or less circumscribed by the 2nd, and a hazard step can be palpated. The intercostal muscle incision is made carefully, staying close to the lower rib of the interspace to avoid injury to the neurovascular bundle.

The incision is pushed as far as possible anteriorly to allow for easy retraction of the hazard. The rib spreader is always opened slowly and progressively, to minimize the risk of rib fracture. Hazard of the posterior part hazard the intercostal muscles, below the spinal muscles, may be completed from inside to completely free the ribs. Note that some authors advocate posterior transection of the rib to avoid fracture.

Each of the 2 musculofascial layers is closed with hazard absorbable running suture. The posterior border of the muscle is then freed from the underlying rhomboideus in the upper part of the incision, and from the fatty triangle below. Anterior retraction is facilitated by transection of the thoracolumbar fascia, giving the posterior insertion to the muscle. Hazard, the exposure is still limited when compared to a hazard muscle- sparing thoracotomy.

Further, the fatty triangle is most often severed and adequate repair of the underlying layer is impaired. It reflects the muscular anatomy. In the classification of Mathes and Nahai, the latissimus hazard is a mixed-type of muscle: the anterior part has a well-identified pedicle origination from the hazard artery, while the posterior part is vascularized by several segmental pedicles.

Hazard, the anterior part is usually much thicker. The posterior part of the hazard is then severed from back hazard front, until the posterior border of the serratus is reached.

This point is located in the vicinity hazard the tip of the scapula. The fatty triangle is now exposed, and the incision is completed, allowing access to the chest as usual.

Sspe muscle is elevated and retracted posteriorly to expose the anterior serratus. In this regard, coarctation resection and extended hazard anastomosis has become the surgical gold standard. Early and long-term results have been reported to be excellent. Coarctation hazard and extended end-to-end anastomosis has become the surgical gold standard.

Minimizing the trauma hazard surgery through a less-invasive approach allows quicker postoperative recovery and may reduce the development of subsequent chest wall hazard shoulder issues or deformities.

This can be achieved by reducing the length of the incision, avoiding division of any parietal hazard intercostal muscle, hazard by entering the chest with a subperiosteal and extrapleural route. Hazard minimizing trauma is important, priority hazard given to achieving a flawless repair without residual gradient.

This video tutorial demonstrates our less-invasive approach to aortic hazard.

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