Muscle sparing thoracotomy in pediatric age: a comparative study with standard posterolateral thoracotomy

Abstract

Alternative approaches to the standard posterolateral incision for thoracotomy have been developed to minimize its postoperative pain and wound related side effects. Muscle-sparing (MS) thoracotomy has been a well-known substitution to the standard posterolateral thoracotomy for this purpose; however it has not been studied in the pediatric age group in detail. We studied retrospectively the patients with thoracotomy for non-cardiac, thoracic surgical procedures. Group 1 included the patients with standard posterolateral thoracotomy for the surgery. The patients with MS thoracotomy composed group 2. The related data were collected retrospectively. The early postoperative morbidities (time requiring for regaining shoulder girdle movement, extubation, intensive care unit stay, and hospital stay) and late musculoskeletal anomalies (scoliosis, elevation of the shoulder, winged scapula, asymmetry of the nipples) were compared between groups. A total of 90 patients were included in the study. Group 1 constituted 50 patients with an average age of 4.24 +/- 2.91 years. Group 2 included 40 patients with an average age of 4.20 +/- 2.92 years. Comparison of the demographics and the baseline characteristics of the patients were not different between groups. In comparison of operative characteristics, there was lesser morbidity in group 2 as re-exploration for bleeding, wound infection, wound healing and fewer intensive care unit and hospital stay days. Late follow-up revealed a significant increase in musculoskeletal deformities in group 1. We conclude that muscle-sparing incision should be preferred to the standard posterolateral thoracotomy in pediatric age.

Thoracic neuroblastoma: a retrospective review of our institutional experience with comparison of the thoracoscopic and open approaches to resection

“…These complications are significantly increased in comparison to a muscle-sparing thoracotomy, including scoliosis (16%-30% vs 2.5%), shoulder elevation (30% vs 7.5%), winged scapula (38% vs 12.5%), and asymmetric nipples (40% vs 12.5%) [10]. One report suggests that the high complication rate associated with posterolateral thoracotomy may be related to increased neurogenic and muscular damage [11].…”

Video-assisted thoracic surgery resection for pediatric mediastinal neurogenic tumors

“…In addition, the results obtained with VATS are similar to those obtained with thoracotomy, with the advantages of better visualization of mediastinal structures, less postoperative pain, reduced hospital stay, and excellent cosmetic results [5]. In addition, this minimally invasive approach can prevent the complications of classic thoracotomy, such as scoliosis, shoulder elevation, winged scapula (scapula alata), or chest wall asymmetry [6].…”

Muscle-sparing Thoracotomy

“…Many of the studies advocating the MST approach have shown that compared with a PLT, patients experienced less postoperative pain, improved shoulder strength and mobility, and demonstrated better preservation of lung function. [6][7][8][9][10][11][12] However, other studies showed no significant differences in these outcomes when comparing the 2 surgical techniques. 1,[13][14][15][16][17] Critics of the MST technique imply that differences in outcomes are not clinically significant or can be attributed to advancements in surgical techniques and anesthesia.…”

“…[29][30][31][32][33] The LD muscle, when preserved, can solely provide adequate reach and bulk of vascularized tissue to address most postlobectomy complications. Although the importance of preservation of the extrathoracic chest muscles for rotational flaps in the event of a postresectional complication has been emphasized in numerous other studies, 1,2,11,12,14,17,34,35 the MST is still not widely utilized. When the LD muscle has been divided, another reconstructive flap option is the serratus anterior muscle.…”