A sternotomy is a surgical procedure involving a vertical incision along the breastbone (sternum). This common approach provides surgeons direct access to organs within the chest cavity. Often called a median sternotomy due to its central placement, its primary purpose is to allow interventions on the heart, lungs, and other structures shielded by the rib cage.
Conditions Requiring Sternotomy
A sternotomy is necessary for treating various medical conditions affecting the heart and lungs. It is the standard approach for many cardiac operations, providing surgeons with clear access and control. This access benefits complex heart procedures, including coronary artery bypass grafting (CABG), heart valve repair or replacement, and heart transplantation.
Beyond cardiac interventions, a sternotomy facilitates corrective surgeries for congenital heart defects. It also provides access for lung surgeries, such as removing mediastinal tumors. Surgeons may also use this approach for tracheal surgery, esophageal reconstruction, or removing large goiters extending into the chest.
Understanding the Surgical Process
The sternotomy procedure begins with a vertical incision along the midline of the chest, extending to the breastbone. A specialized oscillating saw precisely cuts through the sternum from top to bottom.
Once divided, a surgical retractor gently spreads the two halves apart. This creates the opening to access the heart, major blood vessels, and other chest structures. After the primary surgery, the sternum halves are securely joined, usually with stainless steel wires that remain permanently. The skin and underlying tissues are then closed with sutures or staples.
The Recovery Journey
Recovery from a sternotomy involves several stages. The sternum takes about eight weeks for initial healing, with full bone fusion up to 12 weeks. Complete recovery often spans two to three months, sometimes up to six, depending on the individual and procedure. Immediately after surgery, patients wake with a breathing tube, monitoring lines, and receive pain medication.
Wound care involves keeping the incision clean and dry. Patients should use gentle, unscented soap and pat the area dry, avoiding soaking the incision until cleared by their doctor. Activity management follows “sternal precautions” to protect the healing breastbone. These include avoiding lifting over 5-10 pounds for six to eight weeks, and avoiding pushing or pulling with arms.
Supporting the incision with a pillow when coughing or sneezing reduces strain. Walking promotes circulation and prevents complications like pneumonia. While strict weight limits were common, current approaches emphasize “mindful movement,” using pain as a guide. Most individuals resume driving around six weeks post-surgery. Return to strenuous activities like jogging or heavy lifting occurs after three to six months, often with cardiac rehabilitation.
Potential Risks
While sternotomy is a common procedure, it carries potential risks. A primary concern is infection, ranging from superficial wound infections to deep sternal wound infections, known as mediastinitis. Mediastinitis is a serious complication, occurring in 1% to 5% of cases, and can be fatal if untreated. Symptoms often include chest pain, sternal instability, fever, and purulent wound drainage.
Other complications include bleeding, sometimes requiring further surgery. Sternal healing issues can arise, such as non-union (breastbone failing to fuse properly), affecting 0.5% to 3% of patients. Sternal dehiscence, or separation of the sternum halves, is another possibility. Nerve damage, pain, and adverse reactions to anesthesia are also risks. Factors like diabetes, obesity, advanced age, chronic kidney disease, and smoking increase susceptibility to these complications.