What is a sternotomy?
A sternotomy is a surgical incision made through the breastbone (sternum) to access the thoracic cavity. A median sternotomy is the primary approach used for major surgeries in the thoracic region, as it offers a wide view.
- Median sternotomy: an incision down the midline of the entire sternum.
- Hemisternotomy: an incision in the midline of half the sternum on the upper or lower part.
- Clamshell sternotomy (bilateral thoracosternotomy): a partial sternotomy with a horizontal incision on both sides of the sternum in the fifth or sixth intercostal space (space between the ribs) with the ribs retracted for a wider view.
- Hemiclamshell sternotomy (thoracosternotomy): a partial sternotomy with a horizontal incision on either side of the sternum in the fifth or sixth intercostal space.
- Modified thoracosternotomy: a clamshell sternotomy with a modified sternal incision closure technique of the sternum with crossed wires.
Why is a median sternotomy performed?
Median sternotomy: for surgeries in the chest involving
- Blood vessels
- The following procedures may require a median sternotomy:
- Open heart surgeries such as
- Heart transplant
- Coronary artery bypass grafting
- Corrective surgery for congenital heart defects
- Lung transplant
- Surgery for goiter growth in the chest region
- Surgery to reconstruct the esophagus (esophagectomy)
- Removal of large tumors in the thoracic cavity (mediastinal tumors)
- Neurosurgical procedures in the thoracic region for treatment of
- Abnormal tissue growth (neoplasm)
- Bone cysts
- Bone infection (osteomyelitis)
- Spinal tumors
- Vertebral disc space inflammation (discitis)
- Herniation of the disc’s core (nucleus pulposus)
Upper hemisternotomy: for surgeries on aortic and mitral valves.
Lower hemisternotomy: for coronary artery bypass for arteries that need approach from the lower sternum.
Emergency resternotomy: when there is hemorrhage or fluid buildup (tamponade) following a cardiac surgery.
Redo sternotomy: when the aorta or heart is adhered to the sternum.
How is a sternotomy done?
The patient may need hospitalization of 7-10 days depending on the kind of surgery required with sternotomy. A thoracic surgeon performs a sternotomy under general anesthesia.
- The patient undergoes blood and imaging tests.
- The patient must avoid eating or drinking for 8 hours prior.
- The patient must check with the doctor before taking any regular medication
- The patient must inform the surgeon about any allergies.
- An anesthesiologist administers general anesthesia and monitors the patient’s vital functions throughout the procedure.
- The doctor may insert a tube through the patient’s nose or throat to maintain the airway clear and ensure oxygen supply.
- The surgeon may attach defibrillator pads in order to prepare for the risk of irregular heartbeat.
- The surgeon makes an incision in the skin and tissue along the sternum’s midline.
- The surgeon uses a saw to cut through the sternum to expose the thoracic cavity.
- The surgeon performs the required surgery.
- The surgeon usually places chest drains before closing the incision.
- The surgeon uses titanium wires to bind the sternum together or may use a titanium plate with screws.
- An advanced development in sternal closure is using kryptonite bone cement to glue the sternum together.
- The incision is closed with sutures.
- The patient will be administered painkillers and monitored for several hours in the recovery room after the doctor withdraws anesthesia.
Latest Heart News
Daily Health News
How long does a sternotomy take to heal?
Generally, it takes the sternum about six weeks to heal after a sternotomy. The patient must follow certain sternal precautions such as avoiding:
- lifting more than five to eight pounds
- pushing or pulling with the arms
- reaching both arms overhead
- reaching the arms behind the back
- reaching both arms out to the side
What are the risks and complications of a sternotomy?
Surgeries requiring a sternotomy are major procedures. Apart from the risks of the surgery involved, sternotomy may have complications too. The complications of a sternotomy include
- Risks of anesthesia
- Risks of surgery
- Sternal wound infection
- Separation (dehiscence) of sternal surgical joining
- Heart rate problems (dysrhythmia)
- Sternal instability leading to
- Injury to nerves that control the arm and hand (brachial plexus)
- Raised (hypertrophic) scars and keloids
Health Solutions From Our Sponsors
Top How Is A Sternotomy Done Related Articles
A-Fib SlideshowAFib symptoms like heart racing, fluttering, and irregular heart beat may be caused by heart disease, obesity, alcohol use, thyroid disease, and other conditions. AFib medications may include blood thinners, drugs to control heart rate or convert the heart to a normal rhythm. AFib surgery is also a treatment possibility.
Cholesterol Drugs SlidesWhen diet and exercise aren't enough, should you turn to drugs? Learn cholesterol basics, drug classes, and available drugs along with their benefits and side effects.
Congenital Heart DefectsCongenital heart defects are heart problems that are present at birth. Genetics may play a role in some heart defects. Symptoms can range from nonexistent to severe and life-threatening. Fatigue, rapid breathing, and decreased blood circulation are a few possible symptoms of congenital heart defects. Many cases do not require any treatment. Procedures using catheters and surgery may be used to repair severe heart defects.
Congestive Heart Failure (CHF) Symptoms, Treatment, and Life ExpectancyCongestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
Coronary Heart Disease Screening Tests (CAD)
Coronary heart disease or coronary heart disease (CAD) screening tests can be used to potentially prevent a heart attack or cardiac event in a person without heart disease symptoms, and can assist in diagnosing heart disease in individuals with heart disease symptoms. Examples of coronary heart disease tests include:
- electrocardiogram (ECC, EKG),
- exercise stress test,
- radionuclide stress test,
- stress echocardiography,
- pharmacologic stress test,
- CT coronary angiogram, and
- coronary angiogram.
Heart CT ScanEBCT (also referred to as a calcium-score screening heart scan). This test is used to detect calcium deposits found in atherosclerotic plaque in the coronary arteries of heart disease patients. The more coronary calcium means more coronary atherosclerosis, which can raise the risk of future cardiovascular problems.
Heart AttackA heart attack happens when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical instability of the heart.
Heart Attack PreventionHeart disease and heart attacks can be prevented by leading a healthy lifestyle with diet, exercise, and stress management. Symptoms of heart attack in men and women include chest discomfort and pain in the shoulder, neck, jaw, stomach, or back. Women experience the same symptoms as men; however, they also may experience:
- Extreme fatigue
- Pain in the upper abdomen
Leading a healthy lifestyle with a heart healthy low-fat diet, and exercise can help prevent heart disease and heart attack.
Cardiac Arrest: What You Should KnowCardiac arrest is a serious medical emergency that requires immediate medical care. Use this WebMD slideshow to know whether you are at risk for cardiac arrest and what you can do if it happens to a loved one.
Heart SymptomsHeart attacks symptoms vary greatly for men and women, from anxiety and fatigue to nausea and sweating. Learn the warning signs of a heart attack and know the symptoms that may require an immediate trip to the hospital.
Heart TransplantHeart transplant consists of three operations: 1) harvesting the heart from the donor, 2) removing the recipient's damaged heart, and 3) the implantation of the donor heart. The selection and distribution of donor hearts is a careful process so that the hearts are distributed fairly. For the patient requiring a heart transplant, all other important organs in the body must be in good shape. The most common complication of heart transplant is organ rejection.
Heart Valve Disease SurgeryHeart valves that are diseased can be treated both surgically (traditional heart valve surgery) and non-surgically (balloon valvuoplasty). The mitral valve is the most commonly repaired heart valve, but the aortic, pulmonic, and tricuspid valves may also undergo some of these repair techniques.
Implantable Cardiac Defibrillators
An implantable cardiac defibrillator is a device that is inserted into the chest to prevent sudden death from an irregular heartbeat. If the heart develops a life-threatening tachycardia (rapid heart rate), the device administers an electric shock to restore normal rhythm. Cell phones, MRI scanners, metal detectors, and certain heavy-duty electrical powered equipment may interfere with an implantable cardiac defibrillator.
Cardiac Arrest QuizTake the Sudden Cardiac Arrest Quiz. Learning about this potentially deadly condition may save a life.
Thoracic Outlet Syndrome (TOS)Thoracic outlet syndrome is a condition where symptoms are produced from compression of nerves or blood vessels because the passageway through the neck and armpit is inadequate. Symptoms of thoracic outlet syndrome include neck, shoulder, and arm pain, and numbness or impaired circulation to the extremities.