Descrição de técnica cirúrgica para abordagem da cadeia mamária interna em esternos isolados de cadáver

• Autor(a) principal: Valente, Paulla Vasconcelos
• Data de Publicação: 2008
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Federal do Ceará (UFC)
• dARK ID: ark:/83112/0013000017rh0
• Texto Completo: http://www.repositorio.ufc.br/handle/riufc/7024
• topic: Neoplasias da Mama; Biópsia de Linfonodo Sentinela; Linfonodos

To identify the lymph node positioned along the internal mammary vessels in isolated sternum of human cadaver, to distinguish the number of lymph nodes at the second, third and forth intercostals spaces and to standardize the surgical approach to those nodes, in order to establish anatomical landmarks to be used with the current techniques of mammary gland sentinel lymph node detection. Ten sternum plates removed from unclaimed cadavers were used in this study. Sternal plates were removed using bilateral incisions of the ribs at the midclavicular lines. The characterization of the internal mammary vessels and the anatomical integrity of the parietal pleura were indispensable requirements during the procedure. The study was descriptive experimental. A total of 56 lymph nodes were removed from the second, third and forth intercostals spaces, being 30 at the right side and 26 ones at the left side. The second intercostal space was the one that shows the greatest number of lymph nodes in both sides. The lymph nodes of the chain of internal mammary vessels were dissected by a safe and practical technique, different from the one practiced by the Italian surgeons, pioneers at the dissection of the lymph nodes of the internal mammary vessels. The first stage of the dissection consisted of detaching the pectorals major muscle from its attachments to the manubrium and sternal body, exposing the sternocostal joints. Upon identification and detachment of the intercostals muscles approximately five cm from the ribs, special attention is paid to the neurovascular structures located at the superior border of the intercostal space, forming a window in a format of “U”, exposing the internal mammary vessels and the lymph nodes to them related. The approach used is a reliable surgical technique for removing lymph node from sterna plates. The model is therefore valuable for breast surgeons training in sentinel node biopsy, an important procedure for breast cancer patients