The use of axillary skin crease incision for thoracotomies of neonates and children

Abstract

Because of the complications due to "standard" postero-lateral thoracotomy, i.e. winged scapula, scoliosis etc., different muscle-sparing approaches have been published. In 1998 Bianchi et al published their work on axillary skin crease incision for neonates, primarily for the treatment of oesophageal atresia.

Aim of the study: To assess the usefulness of axillary skin crease incision in paediatric surgery.

Methods: Data of 26 cases with axillary skin crease incision were reviewed and the results compared to those of postero-lateral incisions.

Results: Axillary skin crease incision in both neonates and children (up to the age of 15 years) was used to treat both pulmonary and mediastinal lesions and both benign and malignant diseases. The authors performed 17 operations in neonates (8 oesophageal atresia with tracheo-oesophageal fistula, 8 patent ductus arteriosus, 1 congenital cystic adenomatoid malformation) and 9 operations in children (3 neuroblastoma, 1 teratoma, 5 pulmonary operations including lobectomies). The authors were able to perform all operations with unrestricted access through the axillary skin crease incision when the 3rd or 4th intercostal space was necessary for the thoracotomy. The authors compared patients operated with oesophageal atresia through an axillary skin crease incision with patients operated through a postero-lateral incision - seven neonates each. There were no significant differences in the results regarding duration of procedure, duration of postoperative ventilation or the incidence of anastomosis stricture.

Conclusions: Although further long-term studies are necessary to evaluate the axillary skin crease incision, the authors believe that axillary skin crease incision should become the standard method for 3rd and 4th intercostal space thoracotomies in neonates and children.