Rib harvesting begins with dissection down to the external oblique muscle, which can be identified based on the direction of the muscle fibers. Next, the ideal place to split the muscle is identified based on the location of the rib cartilage underneath. Thorough palpation is necessary to distinguish between the 6th to 9th ribs. The access point could be right in the middle between ribs 7 and 8, or sometimes the space between the 6th and 7th rib is large, so the split could be more superior. Between the 6th and 7th ribs, there is often a layer of soft fibrous tissue between the muscle and perichondrium where one might encounter perforator vessels. These must be ligated above the cartilage, otherwise later in the dissection they may be more difficult to find. For the dissection, the entire perichondrium is left intact. The most difficult part of the dissection is where the muscle attaches to the perichondrium at the most peripheral portion of the rib. Here the posterior surface is being dissected. A cut is made at the junction of the bone and cartilage. It is imperative that the perichondrium is elevated from the posterior side, where the perichondrium is typically most adherent, before the cut is made. Here the 7th rib has already been cut, and elevation helps with direct visualization of the posterior surface for further dissection, but be weary to not over-elevate and fracture the cartilage. The sternal end of the rib should be cut where it begins to taper. Here is the cartilage from the 6th rib, which will be placed in a saline and vancomycin solution. Here is the 7th rib. The base frame is made of the 6th, here is the 7th for the helix, and the 8th rib for the antihelix.

rib harvesting

external oblique muscle

perichondrium

cartilage dissection

perforator vessels