The Wilms-Sauerbruch operation of extrapleural thoracoplasty is performed as a routine through a single paravertebral incision. The incision extends from the upper border of the trapezius muscle to a point over the eleventh rib, and is carried down through the layers of muscle to the level of the ribs at the outer border of the erector spinae group.
This incision necessitates transverse section of the trapezius, rhomboids and latissimus dorsi, and is consequently bloody and traumatizing. It is certain that it favors postoperative shock and infection of the wound, complications which, as Archibald has recently brought out, account for most of the direct operative mortality.
Furthermore, when the operation is performed in stages, if even a slight infection occurs after the first or second stage, it is necessary to prolong the interval between operations, frequently to such an extent that the resected ribs regenerate and the final collapse is compromised.