7 Before closure of the incision, 1 or 2 chest tubes are inserted in the pleural space. These tubes are brought out through small, skin incisions that are located below the incision, usually in line with the ipsilateral, anterosuperior iliac spine. This location is preferred because patients can lie on their back without kinking or dislodging the tubes. They can also have active physiotherapy without having to be careful not to displace or disturb the tubes. If a chest tube is directed towards the apex, it should be placed above the superior border of the rib so that it rests against the rib and has no tendency to be displaced inferiorly. By contrast, a chest tube directed towards the base of the pleural space should rest against the inferior border of the rib. For closure of the intercostal spaces, we use 4 to 5 absorbable interrupted sutures (2-0 polyglactin 910) that are passed through a hole made with a rib punch in the lower rib and around the upper rib. This procedure is performed to avoid injury to the intercostal neurovascular bundle. The muscle layer, subcutaneous tissue, and skin are then closed in succession.