Recovering from open heart surgery requires careful physical restriction to allow the breastbone (sternum) to heal completely. The clothing a patient wears directly influences comfort, safety, and adherence to “sternal precautions.” These guidelines prevent undue strain on the healing sternum, which was divided during the procedure and held together with wires. Choosing the right garments is a practical necessity that supports the structural integrity of the chest and minimizes the risk of complications like non-union or infection, ensuring a smoother, safer rehabilitation period.
Essential Design: Front-Opening Garments
The most important consideration for upper-body clothing is the closure mechanism, which must eliminate the need for overhead reaching or twisting. Sternal precautions typically restrict arm movement, prohibiting lifting more than 5 to 10 pounds and avoiding arm elevation above 90 degrees for several weeks while the bone fuses. Pullover shirts or garments with back closures force the arms into unsafe positions, applying shear stress to the newly wired sternum.
Garments that open fully in the front, such as button-up shirts, zip-up robes, or specialized post-operative tops, are mandatory for this reason. A front-opening design allows the patient to dress and undress by simply wrapping the garment around the body and securing the front closure, keeping the elbows close to the torso. Snaps or Velcro closures are often preferred over small buttons or tight zippers because they require less dexterity and fine motor control, reducing fatigue.
For patients immediately post-surgery, especially those discharged with chest drains, specialized adaptive clothing can be beneficial. Some recovery shirts feature internal pockets or loops specifically designed to hold and conceal surgical drain bulbs, preventing them from tugging on the skin or getting caught on objects. Managing these drains within the clothing helps maintain mobility and hygiene while still protecting the sensitive exit sites.
Material Selection and Fit for Incision Care
The fabric itself and the overall fit of the clothing play a significant role in protecting the central chest incision site. The incision, which can be 6 to 8 inches long, is highly sensitive and prone to irritation or infection during the initial weeks of healing. Therefore, all garments must be loose-fitting, ensuring that no pressure or friction is applied directly to the wound or the surrounding bruised tissue.
Soft, non-abrasive, and breathable materials are paramount for preventing skin breakdown and promoting a dry environment around the healing wound. Natural fibers like cotton, bamboo, or specific moisture-wicking blends are excellent choices, as they minimize irritation and allow air circulation, which is crucial for incision care. Rough seams, tags, or stiff embroidery should be avoided entirely, as they can rub against the sternal wound, potentially delaying healing or introducing bacteria.
For female patients, a supportive bra is often recommended to stabilize the breasts and prevent their weight from pulling on the incision. This post-operative bra must be a front-closure design, but it is equally important that it be wire-free and non-constricting, with soft fabric that does not bunch up against the wound site. Some specialized cardiac bras are designed with gentle compression to support the breastbone and minimize swelling without placing undue pressure on the incision itself.
Addressing Lower Body and Footwear Safety
Lower-body dressing must also be simplified to prevent the patient from bending, twisting, or straining to pull clothing up over the hips and legs. These movements can put mechanical stress on the healing sternum and increase intra-abdominal pressure. Loose-fitting pants, such as sweatpants, pajama bottoms, or drawstring trousers, are the best options because they feature wide, elastic waistbands that can be pulled up with minimal bending.
The choice of footwear is a major safety consideration, as falls are a significant risk during post-operative recovery due to fatigue and medication effects. Shoes must be non-slip, offer good support, and have a closed heel to prevent accidental slips. Laces should be avoided entirely, as the bending required to tie them violates sternal precautions.
Slip-on shoes, secure slippers with rubber soles, or shoes with Velcro closures are highly recommended to ensure stability and ease of wear. Tools like long-handled shoe horns or dressing sticks can be employed to assist with putting on socks and shoes without bending over. Many patients are instructed to wear compression stockings to manage leg swelling, especially if a vein was harvested for a bypass procedure. These stockings must be worn as prescribed and often require assistance or specialized donning devices, as the effort of bending over to pull them up is too strenuous for the patient alone.