Finger Lifting Resternotomy Technique

iDepartment of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japanj

Akihiko Yamauchi Satoshi Muraki Yasuko Miyaki
Kazutoshi Tachibana Mayuko Uehara Masaki Tabuchi
Tomohiro Nakajima Yousuke Yanase Nobuyuki Takagi
Tetsuya Higami
We describe a novel method for repeat median sternotomy. We have successfully used efingerf lifting resternotomy technique and achieved zero major cardiovascular injury/catastrophic hemorrhage events at reoperation. After general anesthesia, all patients were placed in the supine position and two external defibrillator pads were placed on the chest wall. We perform a median skin and subcutaneous incision along the previous sternotomy incision extending 3cm distal to the sternum. The sternal wires that had been used for the previous closure were left in place but untied. Using a long electric cautery, right thoracotomy was performed under the right costal arch approach. Then, the operator could approximate the sternal wires in the retro-sternal space. At the same time, the operator could confirm the retro-sternal adhesion status which by touching with a finger. Resternotomy was performed using an oscillating saw pointed toward the operatorfs finger, which allowed safe re-median sternotomy from the lower to the upper part of the sternum. This technique of finger-lifting resternotomy has been employed in 50 cardiovascular reoperations and resulted in 0 incident of major cardiac injury or catastrophic hemorrhage. The finger-lifting resternotomy technique is safe and simple in reoperation procedures and yield excellent early outcomes.
  Jpn. J. Cardiovasc. Surg. 40:269-271i2011j

KeywordsFresternotomy, cardiovascular injury, hemorrhage