Sternotomy

Overview

A sternotomy, also known as a median sternotomy, is a surgical procedure used to reach the heart or other bodily components that the breastbone protects. It is commonly used by cardiac surgeons to gain access to the heart and aortic arch during procedures. To gain access to the heart and perform surgery on it, the surgeon makes a cut through the sternum or breastbone and spreads the two sides apart. The surgeon rejoins the two pieces of the sternum after repairing the heart.

The sternum, commonly referred to as the breastbone, is a narrow and flat bone that extends vertically along the center of your chest, between your left and right rib cages. The lungs and heart are protected by all of these bones. But the easiest way for a surgeon to reach the necessary area when a patient has a heart condition that needs to be treated is frequently by separating and widening the breastbone.

The most common method of accessing the heart without doing a full sternotomy is a mini sternotomy, also known as an upper hemisternotomy. The incision used for a mini sternotomy is only 2 to 3 inches long, or around half the length of a standard sternotomy. The surgical incision commences at the point between your breastbones and descends only as far as approximately the fourth rib.

Reasons for undergoing the procedure

A sternotomy enables a surgeon access to the heart, aorta, and pulmonary arteries, which are protected by the sternum and ribs.

A sternotomy does not remove or repair a bodily part, unlike certain other procedures. With this procedure, a healthcare provider can move a bone out of the way temporarily so they can work on an area beneath it. The majority of the time, a sternotomy is required for the healthcare provider to access the heart.

Risk

The following are possible risks of a sternotomy:

• Abnormal heart rhythm.
• Bleeding
• Infection.
• Swelling.

Before the procedure

Prior to performing a sternotomy, the healthcare provider will:

• Request that the patient take a shower or bath before visiting the hospital.
• Depending on the type of operation, clean the skin on the chest and maybe beyond.
• If necessary, trim any hair on the chest.
• Prescribe the patient with antibiotics.

During the procedure

The surgeon performing your sternotomy will:

• Using a scalpel, make a cut through the skin between the two collarbones. The healthcare provider will cut down to the end of the sternum. In an adult patient, the sternum measures around 6 inches in length.
• Using a sternal saw, cut from top to bottom through the middle of the sternum.
• Insert a retractor to separate their split sternum.
• If the patient is a child, the thymus gland may be removed whole or in part for improved visibility.
• Open the pericardium, the protective sac encasing the heart.
• Use the opening in the pericardium to reach the heart.
• Operate on the heart or any other relevant body part.
• Use eight to twelve sternotomy wires to close the sternum. The medical professional may use a drill to create tiny holes for the wires to pass through if the patient’s bone is too tough for the needle to penetrate.
• Seal the skin and tissues of the chest.
• Apply an antibiotic cream on the incision site.

Stainless steel wires known as “sternotomy wires” are used by surgeons to secure the two parts of the sternum together following heart surgery. Unless the patient has persistent pain or discomfort following surgery, an infection in that area, or requires additional surgery, the wires are usually not removed.

After the procedure

Following a sternotomy, the patient will:

• Need to drain the fluid from their chest.
• If they have any breast tissue at all, they must wear a bra every day. This relieves the weight of their breasts on their incision. The patient should wear this for a week or two following their discharge from the hospital.

Following a sternotomy, the majority of patients can manage their pain with acetaminophen and non-steroidal medications. Some people require stronger medications to manage their pain.

Outcome

A sternotomy offers several advantages in specific medical procedures. This surgical approach gives healthcare providers excellent access to the heart, guaranteeing a comprehensive and accurate procedure. Furthermore, the majority of people tolerate sternotomy rather well. The technique is quick and easy to follow, which adds to the overall surgical process efficiency. Importantly, sternotomy complications are uncommon.

Recovery after a sternotomy takes eight weeks. They must restrict their upper body movement while their sternum heals if they are undergoing cardiac rehab following heart surgery.

While recovering after a sternotomy:

• Avoid lifting more than ten pounds.
• When lifting objects, use both arms.
• When lifting something, keep the arms close to the body.

When recovering from the surgery they underwent following their sternotomy, they will also need to adhere to the guidelines provided by their healthcare provider.

After surgery, the patient should be able to drive once more in about a month. They should sit in the front passenger seat and use a seat belt while their sternum heals. A seat belt and airbag will protect them in the event of a crash, even though they may feel unpleasant on their chest.

Patients and their healthcare provider should schedule follow-up visits on a regular basis. Following a sternotomy, the patient should speak with their healthcare provider if their breastbone:

• Painful.
• Able to move.
• Cracks or pops.
• Fluid leakage from the incision site.