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What Is Median Sternotomy?

Tricia Christensen
Tricia Christensen
Tricia Christensen
Tricia Christensen

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 the procedure, 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.

Heart or lung transplants may require a sternotomy.
Heart or lung transplants may require a sternotomy.

Though this may vary slightly, a typical incision for this procedure 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.

A median sternotomy involves cutting through the sternum, the bone in the middle of the rib cage.
A median sternotomy involves cutting through the sternum, the bone in the middle of the rib cage.

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.

Some heart and lung surgeries require a median sternotomy.
Some heart and lung surgeries require a median sternotomy.

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 procedure 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.

Repairs for congenital defects may require a sternotomy.
Repairs for congenital defects may require a sternotomy.

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.

Tricia Christensen
Tricia Christensen

Tricia has a Literature degree from Sonoma State University and has been a frequent TheHealthBoard contributor for many years. She is especially passionate about reading and writing, although her other interests include medicine, art, film, history, politics, ethics, and religion. Tricia lives in Northern California and is currently working on her first novel.

Learn more...
Tricia Christensen
Tricia Christensen

Tricia has a Literature degree from Sonoma State University and has been a frequent TheHealthBoard contributor for many years. She is especially passionate about reading and writing, although her other interests include medicine, art, film, history, politics, ethics, and religion. Tricia lives in Northern California and is currently working on her first novel.

Learn more...

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    • Heart or lung transplants may require a sternotomy.
      By: 7activestudio
      Heart or lung transplants may require a sternotomy.
    • A median sternotomy involves cutting through the sternum, the bone in the middle of the rib cage.
      By: Jaeeho
      A median sternotomy involves cutting through the sternum, the bone in the middle of the rib cage.
    • Some heart and lung surgeries require a median sternotomy.
      By: Arkady Chubykin
      Some heart and lung surgeries require a median sternotomy.
    • Repairs for congenital defects may require a sternotomy.
      By: Patricia Marks
      Repairs for congenital defects may require a sternotomy.