Sternotomy
A (longitudinal) sternotomy is the term used in surgical terminology to refer to the longitudinal transection of the breastbone ( sternum ).
indication
The partial or total sternotomy is used as an access route for operations on the organs of the mediastinum (middle membrane). Examples are open heart surgery, creation of aortocoronary bypasses , heart transplants, tumors of the thymus gland (very rare). In exceptional cases, the partial sternotomy is also necessary for the operation of very large retrosternal goiter (→ goiter resection , thyroidectomy ).
A longitudinal incision is made across the sternum. The skin and subcutaneous fatty tissue are severed. Local hemostasis is carried out using an electrocautery to dissect the periosteum of the sternum. From above ( jugulum ) and from below ( processus xiphoideus ) the sternum is bluntly passed under with the finger and the loose connective tissue on the back is pushed away. The sternum is cut lengthways in the middle using an oscillating saw or a special jigsaw. The chest can then be opened up to almost any width using a spreader. For partial sternotomy, e.g. B. for the retrosternal goiter, the sternum is only cut lengthways to the second or third intercostal space and then across to the corresponding side.
Clasp
In general, the sternum is closed by means of strong wire loops ("wire cerclages") passed through the intercostal spaces, after drainage has been inserted in the mediastinum if necessary .
Risks and Complications
There are specific complication possibilities of the sternotomy
- Pneumothorax
- Mediastinitis
- Wound healing disorders with osteomyelitis of the sternum and instability
literature
K. Kremer et al .: The surgical diseases of the mediastinum in F. Baumgartl, K. Kremer u. HW Schreiber (Ed.): Special surgery for practice , vol. 1, p. 554 ff., Georg Thieme Verlag Stuttgart, 1973, ISBN 3-13-445301-0
