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At least 235 records · Page 13Linked to original sources
PubMed2002

Surgical treatment of the spine at the cervicothoracic junction: an illustrated review of a modified sternotomy approach with the description of tricks and pitfalls.

The surgical treatment of burst fracture, tumour or spondylitis remains a challenge with regard to the surgical approach to the anterior aspect of the cervicothoracic junction. Many vital structures including osseus, articular, vascular and nervous ones hinder the exposure. Fortunately, indications for surgery in this region are rare. However, when it becomes necessary for the surgeon to expose this region, it is useful to be prepared to approach it carefully. In this investigation the anatomy and exposure of the cervicothoracic junction by means of a sternotomy are described. An illustrated review of the sternotomy approach to the cervicothoracic junction with a description of 'tricks and pitfalls' is provided.

Cervical Vertebrae↗
PubMed2004

Crank-shaped sternotomy for upper mediastinal lymph node dissection in patients with differentiated thyroid cancer.

We describe our modification of the reversed T-shaped sternotomy. The conventional technique consists of a limited upper sternotomy with transverse division of the sternum. Our modification involves shifting the transverse division lines one costal space between the right and left sides for perfect apposition of the divided upper and lower sternum. This technique can be used for patients with thyroid cancer and mediastinal lymph node metastasis and for those with a mediastinal tumor or certain cardiac disorders.

Female↗
PubMed2001

The "mini-elephant trunk" technique of distal anastomosis in total arch replacement through a median sternotomy for a distal aortic arch aneurysm.

A median sternotomy is considered to have several advantages over a left thoracotomy as a route for the surgical treatment of a distal aortic arch aneurysm, including less pain and less lung damage. In a median sternotomy, distal anastomosis is such an important problem that we herein present a useful technique to prevent surgical bleeding from it. An invaginated 40-mm-long graft is inserted into the distal aorta, sutured to the aortic wall, unfolded, and anastomosed with a four-limbed tube graft. We applied this "mini-elephant trunk" technique to total arch replacement for both a saccural distal aneurysm, where the distal aorta was transected, and a fusiform aneurysm, where the invaginated graft was sutured by the "inclusion" method. This technique enables a greater surface contact area between the graft and the aortic wall at the distal anastomosis, thus resulting in a reduced risk of bleeding.

Aged↗
PubMed2003

Changes in hemodynamics in patients who underwent extended mediastinal lymphadenectomy through median sternotomy for primary lung cancer.

OBJECTIVES: Extended bilateral mediastinal lymphadenectomy (ND3alpha) through median sternotomy for lung cancer has been reported to show longer survival compared to that after ipsilateral mediastinal lymphadenectomy (ND2a) through posterolateral thoracotomy for node-positive lung cancer. However, a high incidence of morbidity or mortality has also been found. The present prospective study was conducted to clarify the influence of this procedure on the hemodynamics as one of the factors influencing postoperative course. METHODS: Between December 1999 and January 2001, at the Nippon Medical School Hospital, 10 patients underwent pulmonary resection with ND2a through a posterolateral thoracotomy, while another 10 patients underwent pulmonary resection with ND3alpha through median sternotomy. Changes in the hemodynamics were evaluated preoperatively and at 6, 12, 24 and 48 hours postoperatively. RESULTS: Those who underwent ND3alpha showed higher peripheral vascular resistance for 24 hours postoperatively resulting from the longer surgery and increased blood loss, than those who underwent ND2a. The pulmonary capillary wedge pressure was elevated in those who underwent ND3alpha comparing to that in those who underwent ND2a. Stroke index decreased in patients who underwent NDalpha comparing to that in those who underwent ND2a. Even though the right ventricular ejection fraction showed minimal change, both the ventricular stroke work indices were depressed at 48 hours postoperatively in patient who underwent ND3alpha. CONCLUSION: ND3alpha was concluded to have affected the cardiopulmonary circulation, compared to ND2a, and to be more invasive than ND2a. To perform ND3alpha, preoperative patient selection is an important factor to archive the advantage of increased survival by this procedure.

Aged↗
PubMed2004

Inverted L-shape sternotomy as a minimally invasive approach: re-do cardiac surgery for papillary muscle rupture.

We report a successful treatment of the complete papillary muscle rupture occurring 16 months after coronary artery bypass grafting (CABG). A 57-year-old man was admitted for the sudden onset of chest pain and cardiogenic shock. Emergency cardiac catheterization revealed severe mitral regurgitation and total occlusion in the right coronary artery, which was successfully revascularized by percutaneous coronary intervention under intra-aortic balloon pumping. The right internal thoracic artery grafted to the left anterior descending artery in the previous CABG was functioning well. An echocardiogram distinctly indicated the ruptured head of the papillary muscle. Since an emergency operation revealed complete rupture of the posterior papillary muscle, mitral valve replacement was carried out through an inverted L-shape sternotomy with T-shape left atriotomy. Our case indicates that the inverted L-shape sternotomy was a useful approach to preserve the function of grafts, and that T-shape left atriotomy offered a good exposure of the mitral valve in the limited surgical field.

Coronary Artery Bypass↗
PubMed1991

Anterior sternal retraction for reoperative median sternotomy.

The incidence of reoperative median sternotomy for repeat cardiac surgery is increasing. Reoperative median sternotomy is associated with a higher morbidity and mortality than first-time cardiac surgery. A portion of this morbidity and mortality may be due to direct injury to the heart and great vessels in the process of reopening the sternum. We report a new technique utilizing anterior sternal retraction that allows division of adhesions between the undersurface of the sternum and the heart and great vessels under direct vision. This technique enables the surgeon to minimize the risk of serious injury to these underlying structures during reoperative cardiac surgery.

Cardiac Surgical Procedures↗
PubMed1993

Subxiphoid approach for insertion of ICDs after previous median sternotomy.

To avoid the risks both of repeat median sternotomy and of thoracotomy, the modified subxiphoid approach was adopted for insertion of implantable cardioverter-defibrillators in 10 patients who had previously undergone cardiac operations via median sternotomy. Effective implantable cardioverter-defibrillator systems were implanted in all patients. There were no operative deaths and no hemorrhagic or respiratory complications. One patient underwent repositioning of a dislodged superior vena caval electrode, and an infected generator pocket developed in 1 patient. Early extubation was routine. Two patients were observed in the coronary care unit for the first postoperative night. Postoperative pain was controlled with oral analgesic agents. The subxiphoid approach is safe and effective, and it carries a substantially lower risk of complications than other techniques, even in this high-risk group of patients. By minimizing the need for admission to the intensive care unit, invasive monitoring, and prolonged ventilatory support, by reducing surgical complications, and by shortening the hospital stay, the subxiphoid approach saved an average of $3,295 per patient.

Adult↗
PubMed1995

Prolonged open sternotomy after pediatric open heart operation: experience with 113 patients.

Between April 1990 and November 1993, 1,252 open heart operations were performed in infants and children with congenital heart defects. Prolonged open sternotomy was used in 113 patients (9%) in 10 surgical categories. Thirty-six of these children (32%) were infants and 43 (38%) were newborns. Twenty-four patients (21%) had undergone operation previously; 3 newborns had been treated with extracorporeal membrane oxygenation before the operation. The patients were grouped according to indications for prolonged open sternotomy as follows: group I, 31 patients with squeezed (large) heart syndrome (1 death); group II, 14 patients with hemodynamic instability after sternal approximation (2 deaths/14.2%); group III, 35 patients with low output state after bypass (17 deaths/48.5%); group IV, 21 patients with extracorporeal circulatory assist devices (15 deaths/71.4%); group V, 3 patients with severe arrhythmias (no deaths); and group VI, 9 patients with atypical tamponade that necessitated reopening the sternum in the intensive care unit (6 deaths/66.6%). Overall mortality was 36.2% (41 patients). Four group IV patients were weaned successfully from extracorporeal membrane oxygenation and heart transplantation was performed successfully on two others. All but one of the deaths occurred before delayed sternal closure. After hemodynamic stabilization was achieved, the sternum was closed in all 72 surviving patients with absorbable sutures (in 86% within the first 6 days after operation). In 50 patients (69% of survivors) pericardial substitution with a polytetrafluoroethylene membrane was performed. One newborn with mediastinal infection after extracorporeal membrane oxygenation was treated successfully with retrosternal drain and suction lavage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Successful repair of major retrohepatic vascular injuries without the use of shunt or sternotomy.

Injury to the retrohepatic veins and vena cava secondary to blunt abdominal trauma is often fatal. The purpose of this report is to describe the successful isolation and repair of retrohepatic vascular injuries without the use of median sternotomy or vena caval shunt. Two children with both hepatic vein and retrohepatic caval injuries from blunt trauma were treated by the following surgical approach: (1) bilateral subcostal incision with vertical midline extension; (2) packing of the liver and volume resuscitation with the Rapid Infusion System prior to vascular isolation; (3) isolation of the intrapericardial vena cava through a transdiaphragmatic pericardial window; (4) control of the suprarenal vena cava and porta hepatis; and (5) repair of vein lacerations with vascular occlusion and continuous saline irrigation for improved visualization despite continued venous bleeding. This approach was tolerated and allowed successful repair without shunting in these patients despite an average weight of 14 kg and the loss of 3 L and 23 L of blood, respectively. We attribute the success of this technique to rapid control of hemorrhage and volume resuscitation. This success suggests that the routine use of shunt or sternotomy is not necessary in these devastating injuries.

Child, Preschool↗
PubMed1991

Primary closure of median sternotomy with interposition of hydroxyapatite blocks. A new approach in pediatric cardiac surgery.

Chest closure after correction of congenital heart disease with subsequent enlargement of the heart has been a problem encountered throughout departments performing pediatric cardiac surgery. Present techniques using Rehbein struts or an open chest with a Gore-Tex patch skin closure have not solved this issue satisfactorily. Between January 1989 and September 1990, median sternotomies could not be closed primarily due to hemodynamic consequences in nine patients age 3 months to 19 years operated upon in our department. In three children, a conduit exchange, in two a Mustard correction, in two a correction of Fallot's tetralogy, in one a prosthetic valve exchange and in one, a new implantation of a homograft was performed. Primary chest closure was achieved by interposing hydroxyapatite blocks (50 mm x 15 mm x 6 mm) without hemodynamic consequences. In a follow-up period of 10 +/- 8 months, all children are alive and well. There was no complication resulting from the implanted blocks. Due to the excellent functional and cosmetic results of this technique and the outstanding histomorphological characters of hydroxyapatite, we regard the implantation of hydroxyapatite blocks as a superb method for primary sternotomy closure especially in pediatric cardiac surgery.

Adolescent↗
PubMed2005

Hydrodissection in redo sternotomies.

Injection of pressurized normal saline into the retrosternal tissue has been used in redo sternotomies. This technique has been labeled as hydrodissection. It is a simple but effective technique to help minimize the trauma and risk of complications in redo sternotomies. My colleagues and I present a series of 6 consecutive patients in whom hydrodissection was performed. There was no injury to the heart or any vessel on reentry.

Aged↗
PubMed2005

Preoperative balloon sealing of a false ascending aortic aneurysm for safe redo sternotomy.

Sternal contact of aortic aneurysms in redo operations may require specific techniques to safely control bleeding during sternotomy and surgical dissection. This is the first report on the preoperative use of an inflatable balloon to prevent massive hemorrhage by inserting the balloon--a procedure performed in the cardiac catheterization laboratory--before rethoracotomy. A false ascending aortic aneurysm was successfully sealed by transaortic wire-guided balloon placement from the iliac artery. Gentle traction on the inflated balloon catheter, which was placed inside the false aneurysm, effectively sealed the entrance to the aneurysm. A straightforward median redo sternotomy procedure was subsequently performed without blood loss from the unavoidably opened aneurysm. My colleagues and I propose this technique for aneurysms of mycotic or anastomotic origin, which have an anatomically distinct entry channel.

Aneurysm, False↗
PubMed2005

A median sternotomy approach to right extrapleural pneumonectomy for mesothelioma.

Although pulmonary resections have been performed through median sternotomy, this approach for extrapleural pneumonectomy in the management of malignant pleural mesothelioma has not been described. We assessed the feasibility of a median sternotomy approach as an alternative to thoracotomy in right-sided resections. Over a 15-month period, this approach was attempted in 10 cases. In 7 of them, the entire procedure was completed without additional thoracotomy access. There were no postoperative deaths in this group. At median follow-up of 8 months, we have not encountered tumor progression in the scars.

Follow-Up Studies↗
PubMed2005

Redo submammary incision for median sternotomy and cardiac repair.

BACKGROUND: Minimally invasive and cosmetically attractive approaches are fashionable in conducting cardiac operations. METHODS: We reviewed retrospectively our experience in patients undergoing cardiac operations by means of redo submammary incisions. RESULTS: Fifteen consecutive female patients with a mean age of 13.2 years (range, 0.7 to 44 years) underwent reoperation through a former submammary incision. Seventy-three percent (11 of 15) had median sternotomy, cardiopulmonary bypass, and cardiac repairs. The mean aortic cross-clamp and cardiopulmonary bypass times were 78 +/- 49.7 minutes (range, 16 to 182 minutes) and 114.4 +/- 66.4 minutes (range, 27 to 261 minutes), respectively. Twenty-seven percent (4 of 15) had off-pump procedures; 3 for pacemaker-related issues (1 a third time reentry) and 1 for removal of sternal wires. Mean time interval between the primary submammary incision and reoperation was 5.4 +/- 5.6 years (range, 0.01 to 20 years). Mean first 24 hours Hemovac drainage was 3.2 +/- 2.4 mL/kg (range, 0.4 to 8.5 mL/kg). Mean intensive care unit and hospital stays were 2.1 +/- 1.7 days (range, 0.0 to 5 days) and 5.5 +/- 3.6 days (range, 0.80 to 13 days), respectively. One patient exhibited a chylothorax requiring ligation of her thoracic duct. Another patient had an infected seroma requiring incision and drainage 2 months postoperatively. Skin necrosis and infection were absent in this group. Breast development and lactation were normal. The cosmetic results were satisfactory. There was no mortality. CONCLUSIONS: Redo sternotomies performed through redo transverse submammary incisions are safe for cardiac repair and result in acceptable cosmetic and functional results.

Adolescent↗
PubMed2006

Marzouk's procedure: a novel combined cervical and anterior mediastinotomy technique to avoid median sternotomy for difficult retrosternal thyroidectomy.

Surgery for retrosternal goiter is uncommon. Most of the benign retrosternal goiters can be delivered and resected through a standard cervical incision. However, there are cases in which resection of the retrosternal goiter requires additional thoracic access to the standard transverse cervical incision in the form of partial or complete median sternotomy or even a thoracotomy. We propose and describe a novel technique of combining anterior mediastinotomy to the cervical incision as an adjunct to facilitate delivering the difficult retrosternal goiter by bi-manual manipulation. This technique avoids the trauma and postoperative morbidity of a median sternotomy or thoracotomy and proves effective in solving the technical, functional, financial, and aesthetic problems.

Aged↗
PubMed2006

A wire-cutting clamp designed to reduce complications during sternotomy closure.

PURPOSE: Sternal wire placement frequently results in glove disruption, wound contamination and personnel skin puncture. The described cutting clamp was developed to simplify sternotomy closure and reduce complications. DESCRIPTION: Informed consent was obtained from 103 patients who underwent a variety of common cardiac surgical procedures. In each instance, once the cardiac portion of the procedure was completed, the median sternotomy was closed using standard sternal wires and the described cutting clamps. A single set of clamps was repeatedly re-sterilized and used for all cases. EVALUATION: There were no incidents of unintentional clamp release, glove disruption or personnel skin punctures from the wire. None of the patients had clinically evident sternal wound infections or nonunion. There were no deaths. The functional attributes of the clamps remained constant throughout the study, and no significant wear was detected on the carbide inserts or other components of the clamps. CONCLUSIONS: The sternal wire-cutting clamp simplifies sternal closure and should reduce complications.

Bone Wires↗
PubMed2004

Tracheal release and thymus wrapping of the tracheoplasty anastomosis through mini-sternotomy.

Despite breakthroughs in general thoracic surgery, tracheoplasty remains a technically difficult procedure. The authors performed tracheoplasty on a 75-year-old woman diagnosed with recurrent thyroid cancer and tracheal invasion. Through an L-shaped unilateral mini-sternotomy added to a collar incision, we performed tracheal mobilization and release followed by resection of six tracheal rings. The tracheoplasty anastomosis was then wrapped with the right lobe of the thymus. Using this procedure, tracheoplasty was successfully performed with no complications related to the tracheal anastomosis. Tracheoplasty performed through mini-sternotomy, with a combination of full tracheal release and wrapping with the right lobe of the thymus, may represent a novel, effective, and less-invasive surgical procedure.

Aged↗
PubMed2006

The outcome of sternal wire removal on persistent anterior chest wall pain after median sternotomy.

OBJECTIVE: To evaluate the effect of wire removal on a consecutive series of patients with persistent anterior chest wall pain after median sternotomy. METHODS: Ninety-five patients receiving sternal wire removal during the period January 1994-October 2001 were included in a follow-up study. Preoperative data, data from the primary operation, the postoperative course, and the sternal wire removal were collected from patient histories. The patients were attempted contacted by telephone, and interviewed about the outcome of the wire removal. RESULTS: Wire removals were performed 2.7+/-3.3 (SD) years (40 days-20 years) after the primary procedure. Wire removal appeared to occur more frequently in patients with allergies, patients receiving valve-related procedures, and patients that had been reoperated for surgical complications within the first month after the primary operation. In 79 patients, the pain was unrelated to skin affection or infection. Full follow-up was available for 71 patients. For 24 patients only partial follow-up was possible since the patients were dead (n = 19) or unreachable (n = 5). Of the patients followed up, 86% reported complete or partial relief of symptoms, while 11% reported no change in symptoms, and 3% reported worsening of symptoms after wire removal. In patients (n = 23) where symptoms appeared to be related to specific wires, only these were removed, and this approach produced as good results as for patients where all wires were removed. CONCLUSIONS: The surgical results were generally good. Sternal wire removal should be offered to patients with persistent anterior chest wall pain after sternotomy, when other serious postoperative complications have been excluded.

Adolescent↗