To the Editor.—In the article entitled "The Split Rib Technique" (Arch Surg 110:442, 1975) Dr Narodick wrote that "intercostal incision provides restricted exposure unless adjacent ribs are fractured inadvertently or divided in anticipation of fracture." I take issue with this statement.
Since 1964,I have used only the anterolateral approach via the fourth intercostal space without rib fracture. I do this because the intercostal incision is extended posteriorly between 4 and 6 cm from the costovertebral border, and the skin incision is limited to the edge of the latissimus dorsi. Ample lung exposure is provided for all procedures up to and including pneumonectomy.
Wound closure is performed with running 2-0 chromic catgut sutures to the intercostal muscles and each fascial layer out to the subcutaneous fat, with a running interlocking vertical mattress suture to the skin.
The technique has cosmetic advantages for women and avoids interference with the heavy muscles