ABSTRACT
Procedure Step 1. A posterolateral thoracotomy is performed on the side of pleural soilage.
If there is no pleural effusion, upper to mid esophageal tears should be approached through a right 5th intercostal space thoracotomy. Lower esophageal tears should be approached through a left 7th to 8th intercostal space thoracotomy. Harvest a pedicled intercostal muscle flap with a generous pleural paddle at the time of the incision for later use as coverage of the repair. The ribs are spread gently with a me chanical retractor taking care to protect the muscle pedicle.
