Chest (thorax) formed the thoracic Department of the spine, twelve pairs of ribs and the breastbone (Fig. 1).Breast cage

Fig. 1. Chest: 1 - front; 2 rear; 3 - side

The ribs in the back articulate with vertebrae, front end costal cartilage. Cartilage I-VII ribs articulate with the sternum, VIII - X pair - with cartilage overlying ribs, making the lower front edge of the chest - a costal arch. Last, converging at the xiphoid process of the sternum, form rib angle; the cartilage of the XI-XII ribs are freely. Intercostal spaces are filled with intercostal muscles, here on the bottom edge of each rib go intercostal vessels and nerves. On the back of the rib cartilage, at the edge of a breast bone, top-down pass internal thoracic artery (right and left) and Vienna. Outside the upper part of the chest covered the bones and muscles of the shoulder girdle.

Fig. 2. Conventional line with guidance on the chest and on the front surface (1 - mid front, 2 - sternal, 3 - okoloplodna, 4 - Srednekolymsky, 5 - rib-articular); b - on the lateral surface (1 front, 2 - medium, and 3 - posterior axillary); - on the back side (1 - mid back, 2 - paravertebral, 3 - Krasnoperova, 4 - blade, 5 - scapula).

In the subcutaneous tissue of the breast in women are the mammary glands (see Mammary gland); men have their beginnings. Chest restricts the chest cavity (see). The mobility of joints and flexibility cartilage provide movement of the chest when breathing. The shape of the chest may be wide, short, with rounded rib angle or narrow, long, sharp rib angle. For orientation on the chest use conditional lines (Fig. 2). Malformations of the chest: clefts of the sternum or the absence of the latter (see the pulsation of the heart).
The deformation of the chest are acquired (for example, due to rickets, due to the curvature of the thoracic spine on the soil spondylitis) and congenital. For the last typical: chicken (keel) chest, flattened laterally protruding breastbone, and funnel chest with deeply stuck breastbone. This kind of deformation can be purchased from the constant pressure on the chest (for example, "breast shoemaker" on the pressure pad). When the defects of the sternum and funnel chest, causing the disorder of the functions of chest organs, shows plastic surgery.
Injuries. Compression of the chest - see Asphyxia (traumatic). Rib fractures need to suspect each chest trauma. Often there is a crisis in the field of axillary lines from IV to VII edge; can be broken several ribs or one in two places. Symptoms: severe pain in the injured area in breathing and coughing, feeling "click". At a palpation a sharp pain in a small area rib bone crepitus; sometimes acts of fragments ribs. Treatment - injection 2% solution novokaina (5-10 ml) into the fracture (hematoma). The patient is put on the healthy side, treat the skin with alcohol solution of iodine; injected the needle in place of the greatest pain, certainly over the edge, not to wound intercostal arteries. Punctures the skin, slowly advancing the needle deeper, all the while sipping over the piston, while in the syringe does not seem blood out of a hematoma. Then slowly introduce a solution. If the needle ran to the edge, her little pull and move along the edge in the other direction. Pain after injection disappear, if resumed, they are not generally strong.
The best effect is achieved paravertebral novocaine blockade, more technically complex; it holds a doctor-surgeon in the outpatient setting. The patient needs to assign codeine or dionin inside (0.015 g 3-4 times a day), analgesics (amidopyrine, analgin) and in bed at home; the turnout in the clinic every 3-4 days. Bandages on his chest is not required. If it is impossible to produce procaine the blockade is necessary to impose immobilizers bandage. The chest, back, and sides of the patient grease with kleola and ask him to make a full breath and hold your breath; in this moment quickly lay circular bandage wide bandage (without wool) for the whole thorax. Some patients bandage can cause pain, dyspnoea, then it should be removed. Restriction of mobility of the chest can be achieved by the imposition lipoplasties dressing. Disability with a single fractured rib 3-4 weeks.
At the turn of multiple or aggravated by the breakthrough of the pleura and injury of the lung, which is manifested hemoptysis, subcutaneous emphysema (see), phenomena of pneumothorax (see) or hemothorax (see), it is urgently necessary to refer the patient to a surgical hospital (surgery might be required). For wounds of the thorax these phenomena point to penetrating wound with lung damage; fainting, collapse, the increase of cardiac dullness talk about the injury to the heart. Non-penetrating wound of the thorax dangerous if damaged intercostal and especially internal thoracic artery (bleeding). In all these cases, you need urgent help of a surgeon.

The disease. From purulent processes the most important: mastitis (see) and deep spektralnaya cellulitis. It develops in the tissue under the pectoral muscles, usually as a complication of axillary gidradenit (see) or lymphadenitis (see). Due to the deep localization, primarily severe General condition, pain in the absence of a clear local symptoms (fluctuations). Very dangerous. Early opening wide incision on the outer edge of the chest muscles, penetration finger under his arm into the depth of the fiber and drainage.
From tumors in the chest are more common benign (lipoma, fibroma), malignant tumors possible sarcoma. Surgical treatment.
Operations on the chest. Resection ribs produce: when pathological changes; to open pleural cavity with purulent pleurisy; to access the bodies of the thoracic cavity (see Thoracotomy). Normal or not modified fin repetiruyut under local anesthesia. Progress: the incision of the skin and subcutaneous tissue, hemostasis, expansion wounds hooks; incision of periosteum on the front surface of the ribs, detachment its curved respetaron of Farabee (see Surgical instrumentation); detachment of periosteum with the back of the rib rib raspatory by the Dean; crossing ribs in two places rib scissors and removing the clipping area. Next, depending on the objectives of the operation, follow tamponade, stitches or opening the rear sheet of periosteum and pleura. Biopsy of the pleura may be required urgently, when a large accumulation of water or air in the pleural cavity leads to a sharp compression and the displacement of bodies that threatens the death of the patient. The puncture is made according to General rules (see Puncture) with the following features: the position of the patient in a sitting or poluciaetsea; the puncture site - VIII and IX intercostal space, between the shoulder and the back axillary lines; needle wears it with a rubber tube passes along the upper edge of the edge, to avoid damage intercostal arteries and nerve. Suction of fluid or air to produce slowly better syringe 20 ml through a transitional cannula inserted at the end of a rubber tube. Every time removing the syringe tube should pinching. Continue aspiration is necessary until the termination of air flow (liquid) or until a noticeable weakening of threatening changes in breathing and heart rate.