Page 152 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 11 · Thoracic wall anatomy and surgical approaches

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(a) (b) (c)

(d) (e) (f) (g)
Thoracic wall resection in a dog. (a) When resecting chest wall masses, all contiguous tissue should be excised en bloc with the chest wall mass,
11.7 including biopsy sites (BS). LD = latissimus dorsi muscle. (b) The biopsy tract excision is continued deeply through all soft tissues. The latissimus
dorsi muscle was able to be preserved in this case for autogenous reconstruction of the chest wall defect, but these soft tissue structures should be
excised if required to achieve adequate surgical margins for complete resection of the tumour. (c) Once the soft tissue resection has been performed to
the level of the ribs, an intercostal thoracotomy ( ) is performed one rib caudal to the tumour (as determined from preoperative imaging).
*
(d) Visualization of the rib tumour (arrowed) permits visual assessment of the mass, determination of ventral and dorsal surgical margins in combination
with preoperative imaging, and preparation of the ribs for ostectomy. (e) The intercostal vessels are ligated on the dorsal aspect of each rib to be
resected either individually or, as depicted, with heavy-gauge circumcostal ligatures (arrowed). (f) The ribs are ostectomized immediately ventral to the
ligated intercostal vessels with bone cutters or power saws. (g) The ribs are progressively ostectomized along their dorsal borders until the cranial
aspect of the e cision is identified one rib cranial to the rib tumour. The e cision can then be continued either ventrally or ith the cranial intercostal
thoracotomy.

A partial sternectomy (S) may be required to achieve adequate
11.8
ventral margins for tumours located at or ventral to the esection of the entire affected rib s has been recommended
costochondral junction (arrowed). The costosternal junction should 11.9 because of the possibility of intramedullary extension of the
provide a barrier to tumour extension, but part of the sternum should be rib tumour and resultant incomplete excision if margins were based on
excised to ensure complete surgical excision. the palpable limits of the tumour.

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