The specialized support pillow given to patients immediately following open-heart surgery is not a souvenir or simply for comfort. This item, often heart-shaped and filled with firm stuffing, is a medical tool with a specific purpose for recovery. It is a fundamental component of post-operative care, designed to provide necessary stabilization to the chest wall. The pillow acts as a crucial brace to prevent complications and manage pain, facilitating the aggressive respiratory therapy required for a successful recovery.
Understanding the Sternotomy
The requirement for this pillow stems directly from the median sternotomy, the surgical approach used for most open-heart procedures. A sternotomy involves making a vertical incision down the center of the chest and cutting through the sternum (breastbone) to allow surgeons access to the heart and major blood vessels. Once the procedure is complete, the two halves of the sternum are rejoined, typically secured with strong stainless steel wires.
This leaves the chest wall in a temporarily unstable state. Although the wires hold the bone fragments together, the sternum does not instantly heal; it takes time for the bone to fuse and regain its strength. The healing process generally requires about six to twelve weeks for the sternum to become fully stable. During this period, any force that pulls or pushes the bone fragments apart can compromise the healing site.
The Mechanics of Sternal Splinting
The pillow’s primary role is to act as an external splint, known medically as sternal splinting. When a patient holds the firm pillow tightly against the chest, it provides counter-pressure to the forces acting on the healing bone. This external bracing stabilizes the sternum, limiting the front-to-back movement of the bone fragments. This stability minimizes mechanical stress on the surgical wires holding the sternum together.
By stabilizing the chest wall, the pillow significantly reduces the risk of serious complications, such as sternal non-union (where the bone fails to fuse) or deep sternal wound infection. The compression also reduces incisional pain by preventing the bone ends and surrounding tissue from shifting during periods of increased intra-abdominal pressure. Supporting the incision allows for necessary activities like deep breathing and coughing with less discomfort. This pain reduction enables the patient to perform therapeutic exercises that are otherwise too painful to complete effectively.
Practical Application in Postoperative Recovery
Patients are instructed to use the “pillow hug” technique, clasping the pillow firmly to their chest whenever they anticipate increased chest pressure. The pressure from the pillow counteracts the explosive force generated by these actions, which could otherwise strain the surgical site. This is required for high-pressure activities such as:
- Coughing
- Deep breathing exercises
- Sneezing
- Laughing
The pillow is also used during mobilization to protect the sternum from undue strain. Patients brace with the pillow when getting in and out of bed or a chair, and during bowel movements, which also create internal pressure. Using the pillow for sternal protection is part of sternal precautions, which must be followed for six to eight weeks after surgery. Patients continue using the pillow until their healthcare provider confirms the sternum has sufficiently healed.