Muscle-sparing versus standard posterolateral approach for urgent ‎thoracotomy in patients with traumatic thoracic injuries

Document Type : Original Article


Department of Cardiothoracic Surgery, Faculty of Medicine, Minia University, El-Minya, ‎Egypt ‎


Background: Muscle-sparing thoracotomy (MST) has been proposed as an alternative to standard posterolateral thoracotomy (sPLT) for elective thoracic procedures with limited use in urgent thoracotomies.
Objectives: The aim of this study was to compare the results of sPLT and MST during urgent thoracotomy for the treatment of chest trauma.
Methods: This case series study included patients who underwent urgent thoracotomies within the first 48 hours of admission for treatment of chest trauma, from January 2019 to July 2022. Patients were divided into two groups: sPLT and MST groups. In addition, the MST group was divided into partial (pMST) or complete (cMST).‎
Results: Seventy-five out of 1400 patients with chest trauma (5.3%) underwent urgent thoracotomy, and 30 of them (40%) had MST. Compared with the sPLT group, the MST group had a lower abbreviated injury scale (AIS) of the thoracic region, with a significant difference (4.09 ± 0.66 versus 3.77 ± 0.72, P = 0.052). There was no significant difference between the two groups with regard to the duration of tube drainage, ICU stay, hospital stay, and postoperative complications. The length of hospital stay was shorter in the MST group with no statistically significant difference (14.30 ± 3.01 vs. 15.5 ± 2.48, P = 0.08). The extent of MST, whether partial or complete, had no significant effect on postoperative outcomes.
Conclusions: If it does not impede access or chest exposure, MST can be performed with early recovery and therefore a shorter hospital stay than sPLT.


Yasser Ali Kamal [Pubmed] [Google Scholar]


  1. Ludwig C, Koryllos A. Management of chest trauma. J Thorac Dis. 2017;9:S172-7. doi:10.21037/jtd.2017.03.52 PMid:28446982 PMCid:PMC5392544
  2. Khan IH, McManus KG, McCraith A, McGuigan JA. Muscle sparing thoracotomy: a biomechanical analysis confirms preservation of muscle strength but no improvement in wound discomfort. Eur J Cardiothorac Surg. 2000;18:656-61.
    doi:10.1016/S1010-7940(00)00591-1 PMid:11113671
  3. Akçali Y, Demir H, Tezcan B. The effect of standard posterolateral versus muscle-sparing thoracotomy on multiple parameters. Ann Thorac Surg. 2003;76(4):1050-4. doi:10.1016/S0003-4975(03)00565-4 PMid:14529983
  4. Bethencourt DM, Holmes EC. Muscle-sparing posterolateral thoracotomy. Ann Thorac Surg. 1988;45(3):337-9.
    doi:10.1016/S0003-4975(10)62479-4 PMid:3348708
  5. Ekpe EE, Eyo C. Determinants of mortality in chest trauma patients. Niger J Surg. 2014;20(1):30-4.
  6. Walia BS, Dugg P, Sharma S. Clinical Features, Management, and Outcomes of Chest Trauma at a Tertiary-Care Centre in India: A Retrospective Observational Study. Scientific World J. 2021; 2021:8052586. doi:10.1155/2021/8052586 PMid:34824560 PMCid:PMC8610654
  7. Ertekin A, Öcalan D, Öcalan K, Gencer A. Analysis of patients requiring urgent thoracotomy. Eur Rev Med Pharmacol Sci. 2021; 25 (12):4345-4350.
  8. Mizushima Y, Nakao S, Watanabe H, Matsuoka T. Thoracotomy for blunt chest trauma: Is chest tube output a useful criterion? Acute Med Surg. 2016;3:81‑5. doi:10.1002/ams2.148
    PMid:29123757 PMCid:PMC5667395
  9. Oncel M, Sunam GS, Yildiran H. Recognition and management of traumatic massive hemothorax: Evaluation of 67 cases. Clin Surg. 2017;2:1555.
  10. Karmy-Jones R, Jurkovich GJ, Nathens AB, Shatz DV, Brundage S, Wall MJ Jr, et al. Knudson, M.M. Timing of urgent thoracotomy for hemorrhage after trauma: A multicenter study. Arch Surg. 2001;136:513-18. doi:10.1001/archsurg.136.5.513 PMid:11343541
  11. Elshiekh MA, Lo TT, Shipolini AR, McCormack DJ. Does muscle-sparing thoracotomy as opposed to posterolateral thoracotomy result in better recovery? Interact Cardiovasc Thorac Surg. 2013; 16(1):60-7. doi:10.1093/icvts/ivs295 PMid:23049082 PMCid:PMC3523615
  12. Li S, Feng Z, Wu L, Huang Q, Pan S, Tang X, Ma B. Analysis of 11 trials comparing muscle-sparing with posterolateral thoracotomy. Thorac Cardiovasc Surg. 2014;62(4):344-52. doi:10.1055/s-0033-1337445 PMid:23546873
  13. Uzzaman MM, Robb JD, Mhandu PC, Khan H, Baig K, Chaubey S, Whitaker DC. A meta-analysis comparing muscle-sparing and posterolateral thoracotomy. Ann Thorac Surg. 2014;97(3):1093-102. doi:10.1016/j.athoracsur.2013.08.014 PMid:24209426
  14. Athanassiadi K, Kakaris S, Theakos N, Skottis I. Muscle-sparing versus posterolateral thoracotomy: a prospective study. Eur J Cardiothorac Surg. 2007;31(3):496-9. doi:10.1016/j.ejcts.2006.12.012 PMid:17236781
  15. Ziyade S, Baskent A, Tanju S, Toker A, Dilege S. Isokinetic muscle strength after thoracotomy: standard vs. muscle-sparing posterolateral thoracotomy. Thorac Cardiovasc Surg. 2010; 58 (5): 295-8. doi:10.1055/s-0030-1249829 PMid:20680907
  16. Hazelrigg SR, Landreneau RJ, Boley TM, Priesmeyer M, Schmaltz RA, Nawarawong W, et al. The effect of muscle-sparing versus standard posterolateral thoracotomy on pulmonary function, muscle strength, and postoperative pain. J Thorac Cardiovasc Surg. 1991;101(3):394-400. doi:10.1016/S0022-5223(19)36721-2 PMid:1999932