Surgical Anatomy of the Chest Wall

Abstract

The thoracic wall consists of the osseo-cartilaginous throacic cage, the interconnecting muscles, the muscles on top, the fascia, the nerves and vasculature, the subcutaneous tissue, the skin, and the mammary glands that lie within the subcutaneous tissue. The thoracic cage is pinned by the sternum where the ribs emerging from the vertebrae converge. Flanked by the muscles of the upper limbs the muscles of the thoracic wall include the external and internal intercostal muscles and the diaphragm which separates the thoracic cavity from the abdominal cavity. 12 pairs of thoracic spinal nerves divide into anterior and posterior primary rami to supply the thoracic wall. The anterior rami form the intercostal nerves that further provide branches that innervate the muscles, skin and other structures of the thorax. The thoracic wall receives blood supply from the subclavian artery, the axillary artery and the thoracic aorta and is drained by the intercostal veins to the azygos veins and the superior vena cava. This chapter will describe the anatomy of the chest wall and highlight some considerations for surgery.