Median sternotomy

As a (longitudinal ) sternotomy, the longitudinal separation of the breastbone ( sternum) is referred to in the surgical jargon.

Indication

The partial or total sternotomy is used as an access route for operations on the organs of the mediastinum ( mediastinal ). Examples include open-heart surgery, investment in aortocoronary bypass surgery, heart transplantation, tumors of the thymus gland (very rare). In exceptional cases, the partial sternotomy for surgery also very large substernal goiters required ( → Strumaresektion, thyroidectomy ).

It is carried out over a longitudinal section of the sternum. This skin and subcutaneous adipose tissue are severed. A local hemostasis effected by means of electrocautery is dissected down to the periosteum of the sternum. From top ( suprasternal notch ) and from below ( xiphoid process ) the sternum is under go dull with your finger and the loose connective tissue at the back pushed by it. With an oscillating saw or a special jig saw the sternum is centrally along separately. The chest can be opened wide by a spreader then almost at will. For the partial sternotomy, eg for retrosternal goitre, the sternum is cut lengthwise and then only until the second or third intercostal space to the corresponding side across.

Shutter

In general, the closure of the sternum by means of powerful, guided by the intercostal spaces loops of wire ( " wire cerclage " ) after in need in the mediastinum drains were inserted.

Risks and Complications

Specific possible complications of sternotomy are

• Pneumothorax
• Mediastinitis
• Wound healing disorders with osteomyelitis of the sternum and instability