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5 Division of the intercostal muscles along the upper border of the third or fourth rib, or a subperiosteal excision of thethird rib allows access to the pleural space that is then entered under direct vision.

6 A small, self-retaining retractor is then placed. Further division of the intercostal muscles from within the chest, bothanterior and posterior to the incision, may facilitate widening the intercostal space opening.

60 ERIC VALLIE ` RES

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