Figure 6.

Resection and sternal wedge—part I resection (11). Usually, the preferred surgical access for these lesions is an anterior thoracotomy, with the skin incision prolonged cutaneously onto the midsternal line (Figure 1). In order to obtain a radical resection (R0), the ribs above and below of the involved ones should be resected en-bloc. The pectoral muscles, if not involved by the tumour, are dissected and elevated to access the rib cage. Ribs are then prepared for the resection by scarifying the periosteum of the uninvolved ribs first, with periosteal elevators. Resection is performed with a costotome (Liston) beginning laterally, keeping a safe margin of at least 2 cm from the tumour. The en-bloc mass with the resected ribs are then elevated medially to access the sternum and to verify possible lung infiltration. Attention should be given to the mammary vessels which should be ligated prior resection. A sternal body wedge is then performed by means of both sternal and oscillating saws, the latter allows a more precise sternotomy. A safe margin of the sternal resection is mandatory. A frozen section of the soft tissues can be of help to confirm margin’s clearance. Accurate haemostasis and chest drain placement should be carried out before beginning the reconstruction. Available online: http://www.asvide.com/watch/33047