THE TECHNIC OF RIB RESECTION AND OSTEOMYELITIS OF THE RIB ENDS

My attention was called to the desirability of describing my technic of subperiosteal rib resection by the experience of a single day when I operated on two patients with chronic empyema in whom the persistence of the sinus was found to be due to the sequestration of the ends of the ribs. The advantage of a subperiosteal resection lies not only in the protection which it affords against tearing a nonadherent pleura but also in the fact that the intercostal vessels and nerve are separated from the rib with the posterior layer of periosteum and are thus protected from injury. It must be considered an error of operative technic if the intercostal vessels are wounded during the performance of a simple subperiosteal rib resection.

In the operation which is usually described and figured, a longitudinal incision is made through the periosteum overlying the rib. The anterior layer is then reflected by a