A patient presents with a penetrating chest wound associated with intrathoracic haemorrhage. A thoracotomy is done by taking an incision in the 41h/51h intercostals space staing 1 cm away from the lateral margin of the sternum.This is done to avoid injury to the
C i.e. Internal thoracic aeryIntercostal (external, internal & innermost) muscles (not transverses thoracic) are pierced in pleural taping in mild axillary line.Latissimus dorsi, serratus anterior, rhomboidus major & intercostal muscles are cut in posterolateral thoracotomy whereas pectoralis is cut in anterior & anterolateral approach.Thoracotomy in upper 6 intercostal spaces is done by taking an incision 1 cm lateral to sternum to avoid injury to internal thoracic (mammary) aeryQ.
Pleura
Intercostal aery
Internal thoracic aery
Intercostal nerve