The most important consideration when making a diaphragmatic incision is the preservation of the

A. anterior branch of the phrenic nerve.
B. central tendon.
C. diaphragmatic crural attachments.
D. musculophrenic artery.

Answer A

Incisions in the diaphragm are made with regard to phrenic nerve anatomy. Circumferential incisions placed parallel to the central tendon and costophrenic sulcus on the anteromedial aspect of the diaphragm avoid the major phrenic branches. When radial incisions are used, they should start centrally and proceed peripherally. The left phrenic nerve is more prone to damage when the central tendon is incised because the posterolateral branch crosses the central tendon as it courses toward the posterior axillary line.