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J Thorac Cardiovasc Surg 2007;134:1358-1360
© 2007 The American Association for Thoracic Surgery

Brief Communication

The axillary incision: A cosmetic approach in congenital cardiac surgery

^a Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY
^b Department of Anesthesiology, Mount Sinai Medical Center, New York, NY
^c Department of Pediatrics, Mount Sinai Medical Center, New York, NY
^d Division of Pediatric Cardiology, St Joseph’s Medical Center, Paterson, NJ.

Received for publication June 8, 2007; accepted for publication June 21, 2007.

^_* Address for reprints: Khanh H. Nguyen, MD, Mount Sinai Medical Center, Department of Cardiothoracic Surgery, 1190 Fifth Ave, Box 1028, New York, NY 10029. (Email: Khanh.Nguyen@mountsinai.org).

The first 20% of the full text of this article appears below.

Surgery for congenital heart disease has made great advances, and the focus has shifted from simply surviving the operation to the quality of life after surgical repair, especially when dealing with simple lesions such as atrial septal defects (ASDs). In children and young women, the appearance of the incision has been a significant issue, with concern that it could have an impact on the patient’s psychological wellbeing and self esteem.

Several approaches have been described to avoid a visible midline scar. Most commonly, surgeons have tried using the anterolateral thoracotomy approach, originally described by Lewis and Taufic¹ in 1952. In addition, there have been reports concerning the use of other access sites such as a short right lateral thoracotomy, posterolateral thoracotomy, ministernotomy, a subxiphoid approach without sternotomy, and, more recently, an axillary incision.^2,3 The axillary incision scar is well concealed under the upper arm (Figure 1) and, in prepubescent female patients, poses less potential for subsequent breast tissue distortion.⁴ This article reports the use of the axillary incision at our institution in 34 patients with various congenital cardiac defects.

View larger version (95K):   Figure 1. The scar for the axillary incision is . . . [Full Text of this Article]