The clamshell incision: An improved approach to bilateral pulmonary and mediastinal tumor Journal Article
| Authors: | Bains, M. S.; Ginsberg, R. J.; Jones, W. G. 2nd; McCormack, P. M.; Rusch, V. W.; Burt, M. E.; Martini, N. |
| Article Title: | The clamshell incision: An improved approach to bilateral pulmonary and mediastinal tumor |
| Abstract: | Median sternotomy has been the accepted approach for dealing with mediastinal tumors or bilateral pulmonary disease, but exposure to the lower lobes and to mediastinal tumors extensively involving a hemithorax is often limited. Based on the reported experience from doublelung transplantation, we explored the use of clamshell incisions for these difficult problems. From March 1991 to December 1993, we prospectively studied the utility of clamshell incisions in 90 patients for the following indications: bilateral pulmonary metastases (62 patients), primary lung carcinoma with mediastinal involvement (13 patients), primary tumors of the mediastinum (14 patients), and mesothelioma (1 patient). Bilateral anterior thoracotomies with a transverse sternotomy (clamshell incision) were employed in 71 patients and a unilateral anterior thoracotomy with partial or complete median sternotomy (hemiclamshell incision) was used in 19 patients. For closure, we used pericostal sutures and sternal wires, usually augmented by sternal K-wire stents or Steinmann pins to prevent sternal override. Exposure to all areas of the mediastinum, pericardium, pleura, and lung was excellent. Specifically, the clamshell incision afforded markedly better access to lower lobe disease and hemithoracic extension of mediastinal disease than that possible with median sternotomy. There were no deaths or significant morbidity, and all patients tolerated the incisions well without mechanical respiratory difficulties. There was one wound infection. There was no late sternal override and the cosmetic results were found to be excellent during a follow-up of 2 to 33 months. We conclude that clamshell incisions constitute an inproved surgical approach for the management of bilateral pulmonary or combined pulmonary and mediastinal disease. © 1994. |
| Keywords: | adolescent; adult; aged; cancer surgery; surgical technique; major clinical study; follow-up studies; prospective studies; thoracotomy; lung neoplasms; surgical approach; time factors; lung tumor; lung metastasis; sternotomy; mediastinum tumor; mediastinal neoplasms; thorax surgery; suture techniques; sternum; lung transplantation; middle age; exposure; bone nails; skin incision; human; male; female; priority journal; article; bone wires |
| Journal Title: | Annals of Thoracic Surgery |
| Volume: | 58 |
| Issue: | 1 |
| ISSN: | 0003-4975 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 1994-07-01 |
| Start Page: | 30 |
| End Page: | 33 |
| Language: | English |
| DOI: | 10.1016/0003-4975(94)91067-7 |
| PROVIDER: | scopus |
| PUBMED: | 8037555 |
| DOI/URL: | |
| Notes: | Export Date: 14 January 2019 -- Article -- Source: Scopus |
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