The external intercostal muscles transition anteriorly to an aponeurotic membrane — the external intercostal membrane — in the anterior intercostal spaces where the cartilaginous ribs do not have the same bony contour. This membranous sheet completes the chest wall between the cartilaginous ribs and sternum.
The external intercostal membrane is the structure traversed in anterior chest wall procedures and in intercostal nerve blocks performed near the costal cartilages. Its aponeurotic nature means it provides less mechanical protection anteriorly than the muscular lateral intercostal wall. It is the layer lifted in the subcostal approach to the upper abdomen.
Loss of anterior chest wall support from external intercostal membrane disruption in multiple rib fractures or surgical approaches, contributing to paradoxical chest wall movement in flail chest.
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