854 CORRESPONDENCE

RTlY To the Editor:

Ann Thorac Surg 1990;49847-54

As an orthopaedic surgeon, my involvement with this case was to provide some form of rigid internal fixation stronger than 18-gauge wires for a difficult sternal dehiscence. I then assisted my thoracic surgical colleague in implementing the device in this particular patient. I personally reviewed this patient at 3 to 4 months postoperatively, at which time he was doing well and the roentgenogram that was published in The Annals was taken. All subsequent follow-up of this patient was done by others. At the time of his operation, no osteomyelitis of the sternum was found. I can only speculate that because of the number of procedures that this patient had undergone that a bone infection developed after insertion of the Harrington system. It is well established that bone may not heal in the presence of an infection, and I suspect that this is exactly what happened in this case. I feel that the Harrington compression system is a good method of dealing with difficult sternal problems and in the absence of infection would probably result in solid healing. In the presence of infection and a pseudarthrosis, of course the hardware would have to be removed and more extensive procedures as outlined by Dr Cochran and Dr Rohrich would be necessary. I welcome their comments and their follow-up of this interesting problem.

Robert G. lohnson, M D

400 Medical Center Tower 11 7940 Floyd Curl Drive Sun Antonio, TX 78229-3900

Direct Access to the Paravertebral Space at Thoracotomy To the Editor:

We published a technique of continuous extrapleural intercostal nerve block in The Annals in October 1988 [l]. We would like to bring attention to an improvement in technique that allows more precise placement of the catheter tip within the paravertebral space.

The parietal pleura is raised from the posterior chest wall as far as the vertebral bodies as described in our original publication. At this point, instead of laying the catheter alongside the vertebral bodies, we make a small defect in the extrapleural fascia using Lahey's forceps and pass the tip of the catheter directly into the paravertebral space through this defect (Fig 1). In this way two or three centimeters of catheter lie within the space itself, which is well perfused through the side holes in the catheter. The pleura

Fig 1. The extrapleural fascia (stippled) is exposed by raising the parietal pleura from the posterior chest wall. The epidural catheter is lying within the paravertebral space (broken line), introduced through the small defect.

is reattached, and the paravertebral space is infused with 0.5% bupivacaine for four postoperative days as previously described.

This modification ensures accurate location of the paraverte- bral space and prevents the catheter from becoming dislodged during subsequent closure of the thoracotomy.

Richard G. Berrisford, BSc, FRCS Sabaratnam S . Sabanathan, DM, FRCS, FlCA

Department of Thoracic Surgery Bradford Royal lnfirmary Duckworth Lane Bradford BD9 6RJ England

Reference 1. Sabanathan S , Bickford-Smith PJ, Pradhan GN, Hashimi H,

Eng J-B, Mearns AJ. Continuous intercostal nerve block for pain relief after thoracotomy. Ann Thorac Surg 1988;46:4256.

CORRECTION

"Thrombectomy of the Bjork-Shiley Prosthetic Valve Revisited Long-Term Results" by c . G. Monterot MD, N. Mula, MS, R. Brugos, MDr R. pradas, MD, and D. Figuera, MD (Ann Thorac Surg 1989;48:8248)

The Editorial Office has received a communication from the senior author that indicates the submitted manuscript and sub- sequent publication carry an incorrect author listing. The correct authors are as follows: C. G. Montero, MD, N. Mula, MS, R. Brugos, MD, G. Tellez, MD, and D. Figuera, MD.