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The median sternotomy is a way surgeons gain access to the heart or lungs. It involves creating an incision in the chest and then splitting apart the breastbone or sternum so that the heart’s structures can be fully visible. Once surgery is completed, the bone is wired together to promote healing and the incision is closed. Many patients recover well from a median sternotomy, but sometimes complications result, and scarring is always an outcome. Occasionally, access to the heart may be achieved through other means.
Incising the chest wall and splitting the breastbone provide the most straightforward way to approach the heart or the lungs. This is not necessarily an open-heart surgery, which is better defined as any procedure where the heart is entered through the pericardium, or its outside protective layer. Instead, the median sternotomy means a patient is having an open chest procedure that might include open-heart surgery. Some surgeries that could require a sternotomy include repairs for congenital defects, bypass procedures, or heart or lung transplants.
Though this may vary slightly, a typical incision for a median sternotomy begins right above the sternum. This is just below the base of the throat. The incision is about 8-10 inches (20.32–25.4 centimeters) in length, giving ample room to use a sternal saw to also cut open the breastbone or sternum. While surgery is performed, special spreaders keep the two halves of the breastbone and the tissue and muscle above it apart so that the heart or lungs remain accessible.
After any repairs are completed, surgeons must close the median sternotomy in such a way that will best promote healing. The two halves of the sternum are brought together and carefully wired, so that the bone will heal properly. Both adhesives and stitches may be used to rejoin the muscles and the skin tissue.
When patients are first recovering, the area where the sternotomy was performed may be painful. It may feel especially uncomfortable to raise the arms above the head for a few weeks. Most people ultimately experience total recovery with expected scarring down the middle of the chest.
A complication of a median sternotomy is infection in the bone or the surgical wound. The presence of significant infection might result in a second median sternotomy to remove infectious tissue, or some individuals adequately respond to antibiotic treatment. A small percentage of patients may develop chronic pain over the sternum. Alternately, in a few cases, a sternal wire later loosens and must be removed.
Cardiothoracic surgeons have developed alternatives to the median sternotomy that may be appropriate for certain repairs. A minimally invasive surgery may use a shorter chest incision, roughly half the length of a full sternotomy. Another alternative is to gain access to the heart through two of the ribs, which minimizes scarring. These are not always the best choices, and the sternotomy is often the preferred method because it provides surgeons with more room to perform delicate repairs.