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PubMedDate not supplied

Arteriovenous fistula of internal mammary artery after median sternotomy.

A female patient who had undergone median sternotomy for coronary artery bypass was found to have a continuous murmur on examination one month postoperatively. An arteriovenous fistula involving the right internal mammary artery, thymic, and second intercostal veins was diagnosed with selective angiography. An attempt at embolization of the fistula failed. Therefore, ligation and excision of the fistula was carried out. The etiology was attributed to parasternal wire placement during closure of the median sternotomy.

Arteriovenous Fistula↗
PubMed1987

Repeat sternotomy after reconstruction of the pericardial sac with glutaraldehyde-preserved equine pericardium.

The risk of repeat sternotomy is higher than that of the initial sternotomy, especially if the pericardial sac was left open at the first intervention. In 200 consecutive patients with a pericardial defect after open heart operations, the pericardium was closed with a glutaraldehyde-preserved equine pericardial patch. Precardiac adhesions at reoperation were assessed in four groups of patients on a scale of 6, ranging from 0 (no adhesions) to 5 (calcified or ossified adhesions). Group I comprised 13 patients in whom the pericardium was left open at the first operation and an equine pericardial patch was implanted at reoperation. Group Ia included the first five Group I patients who underwent reoperation less than 1 year (early reoperation) after the initial procedure. Group Ib included the other eight patients of Group I, who underwent reoperation more than 1 year (late reoperation) after the first procedure. Group II comprised nine patients who were reoperated on after reconstruction of the pericardial sac with a glutaraldehyde-preserved equine pericardial patch. After a mean follow-up of 20.2 months, the incidence of patch-related complications was 1%. Statistical analysis shows less severe adhesions on reoperation in Group II patients (pericardial defect patched) than in Group I patients (pericardial defect left open): mean grade of adhesions 1.6 +/- 0.9 (Group II) versus 3.2 +/- 0.6 (Group I), p less than 0.001. Precardial adhesions with the pericardium left open were similar in patients having early and late reoperations: mean grade of adhesions 3.0 +/- 0.7 (Group Ia) versus 3.4 +/- 0.5 (Group Ib), no significant difference. Therefore, the glutaraldehyde-preserved equine pericardial patch can be considered a suitable material for primary closure of the pericardial sac in patients with inadequate autologous pericardium.

Adolescent↗
PubMed1988

Median sternotomy with bilateral bullous resection for unilateral spontaneous pneumothorax, with special reference to operative indications.

Simultaneous bilateral pulmonary operations were done through median sternotomy in 29 patients with unilateral spontaneous pneumothorax, because bullae and blebs of the lung are frequently bilateral. Bullous lesions on the contralateral lung were encountered in eight of 10 patients (80%) in whom no roentgenographic evidence of the additional lesions had been detected preoperatively. Postoperative examination of percent vital capacity was satisfactory (more than 80%) in 21 of 23 patients followed up over a month after operation, and this suggested that simultaneous bilateral thoracotomy through median sternotomy does not lead to a much greater decrease in postoperative pulmonary function than does unilateral operation. To determine the indications for this method of treatment, we investigated the frequency of subsequent development of contralateral pneumothorax in 178 patients who initially had unilateral spontaneous pneumothorax. The occurrence rate of contralateral pneumothorax with visible bullae on chest roentgenograms was as high as 60% and 33.3% in patients in their teens and in those in their 20s, respectively. In conclusion, therefore, the bilateral operative approach should be considered, especially in teenaged patients with contralateral bullae, in whom the highest contralateral occurrence rate of 60% was found.

Adolescent↗
PubMed1988

[Form of manifestations and course of brachial plexus lesions following medial sternotomy].

A prospective study is reported of the prevalence, the clinical picture and the course of plexus brachialis lesions following median sternotomy during heart operations. The study comprises 1,585 patients. In 22 patients (1.39%) a lesion of the lower plexus brachialis was found postoperatively. In 12 patients the plexus lesion was combined with an ipsilateral Horner syndrome. The present study suggests that in spite of cautious use of the sternal retractor, the appearance of a postoperative plexus lesion cannot be completely avoided. In contrast to a cranial incision of the retractor, which can be associated with a posterior fracture of the first rib, a caudal placement of the retractor seems to induce a superior luxation of the first rib and local hematoma without concurrent fracture. Re-examinations of the patients demonstrated a good prognosis of these plexus lesions, the Horner syndromes, however, may remain for a longer time period. It is advisable that patients who have to undergo a heart operation with median sternotomy should be informed beforehand about the possible side-effects described here.

Aortic Valve↗
PubMed1987

Improved technique for closure of median sternotomy incision. Mersilene tapes versus standard wire closure.

A continuous series of 2,135 cardiac surgical procedures performed with a median sternotomy is reviewed. Standard closure with steel wire was used in 1,650 patients, and a new technique with Mersilene tape was used with 485. The rate of sternal dehiscence was 2.4% among those having wire closure, and there were no instances of dehiscence among the 485 patients with Mersilene tape closure (a statistically significant difference at p less than 0.005). The method was quick and easy to perform and highly effective in establishing firm and permanent approximation of the sternum. Presence of factors associated with increased risk of postoperative sternal dehiscence did not affect the outcome when Mersilene tape was used. We highly recommend this technique in all median sternotomy incisions.

Clinical Trials as Topic↗
PubMedDate not supplied

Technique of closure of median sternotomy with trans-sternal figure-of-eight wires.

A technique of closure of median sternotomy with trans-sternal figure-of-eight wires is described. This method has the advantages of very stable sternotomy and can be performed by the surgeon without need for surgical assistance. This technique has resulted in 0.4% incidence of dehiscence and no sternal infections.

Humans↗
PubMed1987

Protecting the brachial plexus during median sternotomy.

Injury to the brachial plexus was prospectively assessed in 335 patients undergoing median sternotomy for cardiac operation. All patients were placed in the hand-up position (elbows elevated, arms abducted 90 degrees, and elbows flexed) after right internal jugular vein cannulation (23 cannulation attempts were bilateral). Twenty-eight patients had new upper extremity complaints after the operation, of whom 16 (4.8%) had symptoms considered related to injury of the brachial plexus: one with generalized weakness of the left arm, six with localized weakness, pain, or paresthesia plus objective hypesthesia or weakness, and nine with paresthesias but no objective signs. Four injuries were right sided, four left sided, and eight bilateral. At the time of discharge, 15 of 16 were symptom free and the patient with generalized weakness was rapidly improving. Postoperative plexopathy was not related to degree of sternal retraction, dissection of the internal mammary artery, or cannulation of the internal jugular vein. We believe the low incidence and benign course of brachial plexus problems in these patients resulted from careful sternal retraction and use of the hands-up position. Finally, our data do not support internal jugular cannulation as a major cause of plexus injuries after median sternotomy.

Brachial Plexus↗
PubMed1985

Median sternotomy for resection of lung metastases.

Three patients operated upon via median sternotomy for resection of bilateral lung metastases are presented. 2 show no evidence of disease 30 and 42 months after operation, one died 10 months after surgery. The literature on the subject is reviewed; median sternotomy is considered a quick, safe and reliable route, indicated when resection of bilateral lung metastases is to be carried out.

Adult↗
PubMed1979

Guidelines for safely opening a previous sternotomy incision.

Operations through a previous sternotomy incision are associated with significant hazards, including cardiac injury, excessive hemorrhage during and after cardiopulmonary bypass, and postoperative sternal instability. A technique for safely opening previous sternotomy incisions has been developed at New York University Medical Center which has proved satisfactory in over 150 patients. It has been demonstrated repeatedly to be free of the serious and often lethal intraoperative and postoperative complications previously associated with this procedure.

Cardiopulmonary Bypass↗
PubMed1985

Treatment of the chronically infected median sternotomy wound with muscle flaps.

While infection and dehiscence of the median sternotomy wound is a serious complication, débridement, sternal rewiring and wound irrigation will often result in wound healing. However, if these measures fail, radical débridement of all infected tissue and immediate reconstruction with muscle flaps is required and will give excellent results. The pectoralis major muscle based on the thoracoacromial artery is most satisfactory for this reconstruction. The rectus abdominis muscle, while also used, is not as effective because of variations in its proximal blood supply. The author describes 10 patients with chronically infected median sternotomy wounds, seen at St. Michael's Hospital in Toronto, in whom use of these techniques led to a rapid recovery with few complications.

Aged↗
PubMed1984

[Roentgenologic observation of the course following sternotomy].

The course of healing after medial sternotomy can be controlled by means of tomography of the sternum. If healing progresses in a normal way, restitution can be seen in the region of the corpus sterni after about 20 days, whereas restitution in the area of the manubrium sterni is evident after 8 weeks only. Osseous absorption is a leading x-ray sign of disturbed restitution, the other leading sign being persistence of dehiscence of the sternum following sternotomy.

Humans↗
PubMed1984

[Simultaneous bilateral operations for bullous emphysema by median sternotomy].

Eighteen patients with bilateral bullae underwent simultaneous operations via median sternotomy. Each patient had giant bullae occupying at least one third of the each hemithorax and also had various degree of exertional dyspnea. All patients showed subjective as well as objective improvement and there was no mortality or morbidity. Late follow-up study for objective evaluation of this operative procedure clarified that the forced expiratory volume for one second (FEV1.0) and arterial oxygen tension (PaO2) were significantly improved after the operation, whereas the vital capacity and arterial carbon dioxide tension (PaCO2) showed no apparent changes. Serial study of cardiopulmonary hemodynamics during the bilateral thoracotomy was performed with Swan-Ganz catheter and hemodilution method. By abrupt decompression of the cyst, decreases in pulmonary arterial pressure, cardiac output, or systemic arterial pressure were noted during the bilateral thoracotomy. These hemodynamic changes were much more evident in the cases ventilated by single lumen tube than the cases operated upon using double lumen tube with separate ventilation. This operative procedure was applied on the cases with bilateral spontaneous pneumothorax and metastatic lung tumor. The clinical advantages of this bilateral operation via median sternotomy were discussed.

Adult↗
PubMed1984

Partial median sternotomy: anterior approach to the upper thoracic esophagus.

Based upon experience with cervicothoracic esophageal carcinomas in which resection of the manubrium, adjacent clavicles, and ribs has facilitated exposure of the tumor, it has been found that a partial upper sternal split (without resection) provides access to the upper thoracic esophagus to the level of the carina. With a knowledge of the anatomic relationships of the esophagus in this area, this direct anterior approach has been used for both benign and selected malignant diseases involving the upper thoracic esophagus. A partial median sternotomy has been used in 11 patients with the following esophageal pathology: upper- and/or middle-third malignancy (six), benign upper-third stricture (three), perforation of upper-third esophagogastric anastomotic stricture (one), and cricopharyngeal achalasia in association with a chronic cervical compression fracture that prevented extension of the neck (one). The following operations were performed: blunt esophagectomy with cervical esophagogastric anastomosis (six), segmental esophageal resection with primary anastomosis (three), drainage of perforation (one), and extended cervical esophagomyotomy (one). A chylothorax developed in one patient with carcinoma, the only major postoperative complication in this group. Transient hoarseness occurred in two patients. Careful evaluation of the patient with upper thoracic esophageal pathology, focusing on the type, extent, and location of the abnormality relative to the level of the carina, as well as the habitus of the patient, often indicates that a partial sternotomy can be utilized to facilitate the operation.

Adult↗
PubMed1978

[Major complications of median sternotomy].

After examining the modalities of sternal perfusion and the techniques of median sternotomy, with special regard to closure techniques, personal experience of 1000 sternotomies is reviewed. Complications may be major or minor, incidence was 1,8% and total mortality two cases. After reviewing the various causes of sternal dehiscence, reported and personal experience of the various techniques for preventing and treating the complication is discussed.

Adolescent↗
PubMed1980

Median sternotomy for synchronous bilateral pulmonary operations.

Since 1975 10 patients at Rush Medical Center have undergone synchronous bilateral pulmonary operations by median sternotomy. Nine had pulmonary metastases and one had bullous emphysema with recurrent spontaneous pneumothorax. Between three and 20 metastases were removed by wedge resection per patient, but right upper lobe anterior segmentectomy and left upper lobectomy were required in one patient. Bilateral bullae resections and plications improved pulmonary function in the patient with emphysema. The average hospital stay was 9 days, and the only complication was one reoperation for postoperative bleeding. Median sternotomy has been advantageous in selected patients with bilateral pulmonary disease because it allows one-stage completion of the required pulmonary procedures with minimal impairment of pulmonary function, shortened hospital stay, and maximal patient recovery.

Adolescent↗
PubMedDate not supplied

[Sternotomy for the treatment of cervical stenosis after esophagocoloplasty: 3 case reports].

Colon interposition for benign esophageal disease has so many complications among them stricture and anastomotic leak are the most common. Three patients with esphagocolonic stricture due to colon interposition have been successfully treated by sternotomy after being submitted to endoscopic balloon dilatation. Sternotomy would seen a safe and reliable method for treating anastomotic stricture in patients with recurrent stenosis after esophagocolonic anastomosis due to extrinsic compression.

Adolescent↗
PubMed1995

[Yolk sac tumor resected by transverse sternotomy: a case report].

Transverse sternotomy was performed in a 39-year-old man having bilateral lung metastatic lesions of yolk sac tumor. This approach provided an excellent operative field. Bilateral partial lobes including parietal pleura and diaphragma were readily resected. As described in this paper, transverse sternotomy is one of the beneficial method in the thorough surgical treatment for metastatic bilateral lung lesion.

Adult↗
PubMed1995

[Chest pain in a patient after median sternotomy].

A 62-year-old woman presented with a 1-year history of painful operative scar following median sternotomy performed for coronary artery bypass grafting at another hospital shortly after myocardial infarction. She had a 5-year history of diabetes mellitus, which had been controlled with diet therapy. There were no abnormalities in electrocardiographic or cardiac function. She complained of burning pain and marked tenderness bilaterally in the parasternal region. There were no abnormal laboratory findings. No fractures were detected in the ribs or sternum radiographically. Her chest pain was not alleviated by analgesics including nonsteroidal anti-inflammatory agents or tricyclic antidepressants. Neither local anesthesia nor thoracic epidural anesthesia was effective in eliminating her pain. Slight relief was obtained by heating with infrared radiation, but the duration of pain relief was very short. This patient's findings indicate that painful operative scar should be considered as a potentially serious complication of surgery requiring median sternotomy.

Chest Pain↗