Post-it Sunday 10/1/23-Skin, a memoir by you-thoracic incisions

The post-it states “Skin is a map of your history.”

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Last week I accidentally started another series when I started to write about how skin is a map of your history. A memoir of you.

I wrote about abdominal incisions/scars and I decided to end the post there. Because the body is a LOT of territory to cover, and it is best broken down in zones.

The zone of the week is incisions of the thoracic, aka the chest.

Four things can be gotten to through an incision on the chest. The lungs, the heart, and the mediastinum, and the esophagus. Although it is more accurate to say that the esophagus is just passing through.

Ha!

I’m here five posts a week.

And I nearly forgot about the diaphragm, the floor of the thoracic cavity.

There is the median sternotomy incision. This is how they “crack” your chest for major heart surgery. It goes from the suprasternal notch (between your collarbones) to below the xiphoid (the end of the sternum). This incision takes two months to heal at a minimum and is very painful as well.

They crack your sternum to work on your beating heart.

To access the lungs or the pleural cavity there are the thoracotomy incisions. These are named for the approach. There is the posterior-lateral incision, the axillary incision, and the anterolateral incision.

The posterior-lateral incision actually starts on your back, under the scapula and around to the side. This is the gold standard incision for lungs. This incision is used to resect part of the lungs, surgery on the esophagus, and can be used to resect part of the chest wall.

The anterolateral incision is from the sternal border (the big bone running down the chest) to the mid-axillary line. This is used for some lung surgeries, some heart surgeries, such as valve replacement, and some esophageal surgeries.

The axillary incision is a straight incision underneath your armpit. This is a muscle-sparing incision used for some pneumothorax surgeries including pneumonectomy. This means that the muscles of the chest are not transected and the patient doesn’t have to heal them. But there are limitations to what can be reached with this approach.

There are other incisions and scars that can be found on the chest.

The pacemaker incision is for the insertion of a pacemaker to control the heartbeats. This is usually under the clavicle on the left side. Also of note is the pacemaker itself under the skin. Usually about 4 cm x 5 cm with a rounded upper edge.

Sometimes an implantable intravenous port is necessary. Often called a port or portacath, this is used for administration of chemotherapy medications. Sometimes it is used when long-term parenteral nutrition needs to be given because you are not able to eat for a variety of reasons.

There can also be an orthopedic incision on your chest. Specifically on the clavicle. This is an incision over the clavicle bone for open reduction, internal fixation of the clavicle for fracture.

Next week on this accidental series, I will be discussing head and neck incisions.