How Is A Sternotomy Done?

A sternotomy is a surgical opening in the middle of the chest at the breastbone (sternum) to provide access to the chest cavity for heart procedures or other thoracic surgeries.

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.

Median sternotomy: for surgeries in the chest involving

• Lungs
• Heart
• Esophagus
• 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
• Fracture
• 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.

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.

Preparation

• 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.

Procedure

• 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.

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

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
  • Headache
  • Nausea
  • Confusion
• Risks of surgery
  • Infection
  • Bleeding
  • Blood clots
  • pneumonia
• Sternal wound infection
• Separation (dehiscence) of sternal surgical joining
• Hemorrhage
• Heart rate problems (dysrhythmia)
• Sternal instability leading to
  • Sternum and rib pain (costochondritis)
  • Clicking sensation on movement
  • Sternal instability while coughing
• Injury to nerves that control the arm and hand (brachial plexus)
• Raised (hypertrophic) scars and keloids