This document describes the transsternal approach for accessing the upper thoracic spine. It involves making a Y-shaped or straight incision from the suprasternal notch to the xyphoid process. A sternotomy is then performed using a Gigli saw to open the sternum. The brachiocephalic vessels are bluntly dissected and retracted to expose the thoracic spine, and the innominate vein may be ligated. Diagrams show the skin incision and retraction of surrounding structures like the esophagus, trachea, and brachiocephalic vein.

1. TRANSSTERNAL APPROACH
1) Y-shaped or straight incision – suprasternal notch to xyphoid
process
2) Sternotomy with Gigli saw after reflecting parietal pleura from
posterior sternum
3) Blunt dissection and retraction of brachiocephalic vessels
4) Possible ligation of innominate vein

2. The skin incision for the transsternal approach
to the upper thoracic spine.

4. TRACHEA
ESOPHAGUS
MANUBRIUM
SPLIT
THORACIC DUCT
CAROTID ARTERY
INTERNAL
JUGULAR VEIN
LEFT
BRACHIOCEPHALIC VEIN
The esophagus, trachea and brachiocephalic vein are retracted to the
right while the lung, common carotid artery and thoracic duct are
retracted to the left.