Median sternotomy for primary lung tumors.
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A limited sternal splitting incision is useful for the surgical approach to different diseases of the upper mediastinum. To provide optimal exposure, a specifically designed sternal retractor has been developed. Through a V-shaped opening and elevation of the sternum, surgery of the thymus gland, mediastinal goiters, and, more generally, biopsy or resection of most anterior mediastinal masses are possible. The device has been used in 30 patients who had different diseases, with totally satisfactory results.
A method for exposure of the heart, ascending aorta, aortic arch vessels, and descending thoracic aorta in a single surgical field is presented. Five illustrative cases are reviewed. Indications for use include trauma to the aorta and arch vessels, aneurysms or dissections, ductus aneurysms, or complex or secondary coarctations of the aorta.
Usual techniques in open-heart operations leave a vertical median skin scar. Especially for women this is rather embarassing since it looks ugly. The use of horizontal submammary skin incision for access to the heart is described here. Although obtaining the usual midsternal exposure takes some extra time, long-term results have shown the value of this approach and its benefit to the patient. The surgical technique is simple, and wound healing, in the long run, is unimpaired.
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A simple method for safely repairing a wire broken during sternal closure is described. This method ensures secure closure when other methods may be hazardous.
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