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 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.
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.
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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
- 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
