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J Thorac Cardiovasc Surg 1999;117:1044
© 1999 Mosby, Inc.

LETTERS TO THE EDITOR

Reply

First Department of Surgery
Tokyo Women's Medical University
8-1 Kawada-chou Shinjuku-ku
Tokyo 162-8666, Japan

Reply to the Editor:

We also recognize the importance of maintaining the integrity of the clavicle with its articulation with the manubrium and its muscular insertions. Spaggiari and Pastorino concluded that our method does not maintain the integrity of the clavicle because there was insufficient fixation in 3 of our 5 cases. However, they were the early cases. Our problem in the early period lay in the method of fixing the sectioned clavicle. However, besides gaining some technical experience, we solved the problem by fixing the clavicle with a new material, slightly thicker titanium plates. No problems at all have been encountered in the 2 most recent cases. The patients are even bowling with the arm on the side of the operation.

Section of the manubrium is also possible with our method. When performed, it would probably be done by the ordinary thoracic approach. Spaggiari and Pastorino have stated that our method and their method are completely different procedures. Although we also considered the procedure from a totally different viewpoint, when we evaluated the matter thoroughly, it seemed reasonable to conclude that our method is also a TMA.

The main portion of our report says that "sectioning the clavicle in the TMA makes it possible to enlarge the field of vision and at the same time maintain clavicle integrity." An approach to a fairly large portion of the great vessels in the thoracocervical area may very well be possible without sectioning the clavicle if the procedure is performed carefully. However, the field of vision obtained by sectioning the clavicle makes it possible to visualize the great vessels in the thoracocervical area frontally in a way that cannot be compared with the exposure available when the clavicle is not sectioned. The field of vision must be enlarged if the operation is to be performed safely.

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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Onuki, T. Search for Related Content PubMed Articles by Onuki, T.