What is a sternotomy?

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 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.

Why is a median sternotomy performed?

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.

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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.

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.

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
  • Hemorrhage
  • Heart rate problems (dysrhythmia)
  • Sternal instability leading to
  • Injury to nerves that control the arm and hand (brachial plexus)
  • Raised (hypertrophic) scars and keloids

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Medically Reviewed on 4/8/2020
References
Medscape reference
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