Abstract
For tumors located in the back that are close to the vertebral spine, a longitudinal, vertical, paraspinal elliptical incision (which includes a biopsy incision) is preferable, particularly when the tumor mass is longitudinally disposed (Fig. 18.1). (A T incision consisting of a vertical and horizontal component may occasionally be required.) The medial flap is raised to beyond the spinous processes. Laterally, the flap is raised to well beyond the palpable extent of the tumor. The deep fascia is incised (Fig. 18.2). Superiorly and laterally, the trapezius muscle is encountered as the first layer and is divided. Depending on the location of the tumor in the inferior part of the wound, the latissimus dorsi is exposed and divided around the tumor (Fig. 18.3). Medially, the aponeurotic layer next to the supraspinous ligament is divided in the plane between the spinous processes and the sacrospinalis muscle (Fig. 18.4). With further dissection, the sacrospinalis muscle is separated from the spinous processes to the surface of the lamina. The rhomboid muscles at the level medial to the scapula are divided (Fig. 18.5). Dissection on the surface of the intercostal muscles and ribs then is carried out to some extent, in order to evaluate the proximity of the tumor to the fascia covering the intercostal muscles. If there is any evidence of fixation of the tumor to the rib surface laterally, the involved ribs are divided and the pleura is entered. To assess the situation, a 2-cm segment of each divided rib is removed, allowing digital exploration of the inner side of the chest wall (Fig. 18.6). The sacrospinalis muscle is divided both above and below the tumor. The involved ribs, which have already been divided laterally, are disarticulated medially and the specimen is removed (Fig. 18.7).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Suggested Reading
Ghosh J, Eglinton T, Frizelle FA, Watson AJ. Presacral tumours in adults. Surgeon. 2007;5(1):31–8.
Harry BL, Deleyiannis FW. Posterior trunk reconstruction using an anteromedial thigh free flap and arteriovenous loop. Microsurgery. 2013;33:416–7.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer Science+Business Media New York
About this chapter
Cite this chapter
Karakousis, C.P. (2015). Tumor in the Back. In: Atlas of Operative Procedures in Surgical Oncology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1634-4_18
Download citation
DOI: https://doi.org/10.1007/978-1-4939-1634-4_18
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-1633-7
Online ISBN: 978-1-4939-1634-4
eBook Packages: MedicineMedicine (R0)