The Median Sternotomy: The Unkindest Cut of All? Pearls, Pitfalls, Aphorisms, & Myths

Abstract

While some have claimed that a median sternotomy is an ‘unkind cut,’ when this incision is performed, closed, and managed optimally, it can be one of the ‘most kind cuts’ used for major operations. The median sternotomy is the most commonly used incision for coronary artery bypass surgery, which is the most common operation performed in the United States at the current time. This approach is, of course, used for many other cardiac and thoracic operations, as well. It is, however, also one of the most misunderstood procedures in Surgery. Because it is an incision that even a novice surgical resident can perform, with proper supervision, the subtleties and nuances of not only opening but also of closing sternotomies are not often conveyed optimally to our trainees. In this treatise we will attempt to comprehensively address these subtleties, nuances, and misunderstandings, both for the benefit of our younger learners, but also, and more importantly, for the benefit of our patients.

Risk factors associated with surgical site infections in patients undergoing cardiothoracic surgery: A systematic review and meta‐analysis

“…This reduced trauma to the chest wall and surrounding musculature results in less post‐operative pulmonary function compromise, a crucial advantage for patients with pre‐existing pulmonary conditions 4 . Despite the rapid advancement and adoption of minimally invasive techniques, these often cannot replace the median sternotomy in surgeries requiring complex reconstructions, such as extensive coronary artery bypass grafting involving multiple vessels, combined valve repairs with aortic reconstruction and complex congenital cardiac repairs, as well as in scenarios necessitating multiple simultaneous procedures 5–7 . For these reasons, the median sternotomy remains an indispensable surgical approach, granting cardiac surgeons' comprehensive access to both the cardiac and vascular systems for effective surgical intervention.…”