Technique of Diab et al. for scapulothoracic fusion (see text). A, Vertebral border of scapula and ribs are seen after surrounding muscles, fat, fibrous tissues, and periosteum have been cleared. B, Five doubled, 16-gauge wires are passed subperiosteally under the ribs and twisted on themselves to prevent impingement on the pleura. Five holes are drilled in medial aspect of scapula, adjacent to planned point of attachment to ribs. C, Single plate is bent to conform to shape of scapula, and one end of each wire is passed through drill hole and corresponding plate hole. Bone graft is placed between anterior border of scapula and posterior surface of ribs. D, Other end of each wire is pulled to posterior side of scapula and plate and tightened to firmly press scapula against ribs.