basic anatomi for toracic surgery 1.pptx

Mteri

1. Anatomical B asic of thoracic surgery I Wayan Sudarma

2. Components of the thorax Bones : Thoracic vertebrae Ribs 1-12 Sternum Plus scapula and clsvicula

3. Superficial layers Skin and fat Deep fascial compartments Fascia muscle groups body cavities Lung, blood vessel, and heart Components of the thorax

4. THORACIC CAVITY AND CHEST WALL THORACIC CAVITY: superior thoracic aperture (Th2) Borders: Th1, 1st ribs, sternum, pleura inferior thoracic aperture (Th10) Borders: Th12, 11-12th ribs, costal arch, xiphoid process

5. Chest wall intrinsic and extrinsic muscles

6. Chest wall intrinsic and extrinsic muscles

7. PLEURA AND LUNGS

8. THE MEDIASTINUM The boundaries of the mediastinum : Superior thoracic inlet Inferior the diaphragm Anterior the sternum and costal cartilages Lateral mediastinal  parietal pleura Posterior the ribs and thoracic vertebrae 

9. Tampak klinis regio toraks

10. What is Thoracotomy? It is process of making an incision into the chest wall Performed by surgeon, to gain acces to the thoracic organs : heart, lungs, esofagus , thoracic aorta,tumor in mediastinum Lateral decubitus is an ideal position to perform thoracotomy

11. Approach to Thoracotomy There are 2 main subtypes of thoracotomy incicions : Posterolateral Incision Anterolateral Incision

12. Posterolateral Incision It is a gold standar for access to the thorax, It is very common approach for operations on lungs, when performed on 5 th ICS its allows optimal access to pulmonary hilum Incision of choise for pulmonary resections : pneumonectomy & lobectomy Incision begins approximately 3cm posterior to the scapula tip and approximately halfway between the scapula and the spinous process

13. Posterolateral Incision

14. Posterolateral Incision Right lateral thoracotomy: Identify the thin mediastinal parietal pleura. right phrenic nerve and pericardiaco ‐ phrenic vessels where they run between the mediastinal parietal pleura and the fibrous pericardium.  azygos vein.  Left lateral thoracotomy   Identify the thin mediastinal parietal pleura. the left phrenic nerve and pericardiacophrenic vessels where they run between the mediastinal parietal pleura and the fibrous pericardium the left  pulmonary artery, left main bronchus, and inferior pulmonary vein. the descending  aort

15. ANTEROLATERAL THORACOTOMY Incision can be used in a variety of operation for cardiac, pulmonary and oesophageal pathology Patient placed in lateral decubitus position. Arm placed in classic “swimmer” position with 90‐ degree abduction of the upper arm to allow easier access to 4th ICS

16. EMERGENCY LEFT ANTEROLATERAL THORACOTOMY

17. EMERGENCY LEFT ANTEROLATERAL THORACOTOMY INDICATIONS: Salvageable postinjury cardiac arrest Persistent severe postinjury hypotension (SBP < 60 mm Hg) due to: cardiac tamponade Hemorrhage ‐intrathoracic, intra‐abdominal, extremity, cervical

18. CLAMSHELL INCISION (BILATERAL THORACOSTERNOTOMY) This incision is used in rare circumstances where broad exposure is needed within both hemithoraces simultaneously include double lung transplant removal of bulky anterior mediastinal masses with lateral extensions beyond the midclavicular lines, removal of bilateral multiple suspected metastases

19. MEDIAN STERNOTOMY This incision is used widely for cardiac surgery, resection of anterior mediastinal masses, radical thymectomies, dissections of the upper mediastinum. It also can provide access to both hemithoraces for bilateral pulmonary nodules or lung volume reduction surgery.

20. PARTIAL STERNOTOMY A partial sternotomy generally splits the manubrium and the upper portion of the body of the sternum. It provides access to the thoracic inlet, as well as the upper anterior and upper midmediastinal structures. It is particularly useful in approaching the thymus gland and is easily combined with neck incisions to provide proximal and distal control of upper mediastinal arteries and veins.

21. Terimakasih