One of the best autogenous bone graft harvesting method is taking the
tenth rib all the way back to its vertebral body. It is best to harvest
the tenth rib from the outside back to the spinal extensor muscles and
then from the inside from the spinal extensor muscles to the
articulation with the vertebral body. This makes closure easier and
preserves the spinal extensor muscles. It can be thought that it is
hard to reach to the T10 vertebral body through a tenth rib
thoracotomy, and that taking the eighth or ninth rib is easier.
However, taking the eighth or ninth rib usually causes more disruption
of the serratus anterior muscle. Getting to the superior order of the
tenth vertebral body is difficult if one only harvests the tenth rib
back to the spinal extensor muscles. But if the tenth rib is
disarticulated from the vertebral body, then access to the superior
portion of T10 is quite straightforward.
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