link
Bookmarks
Sternotomy
John P. Lichtenberger, III, MD; Diane C. Strollo, MD, FACR
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Subscribe
0
8
4
0

KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Median sternotomy (MS)
            • Clamshell sternotomy (CS)
          • Synonyms

            • CS: Transverse sternotomy, cross-bow incision
          • Definitions

            • MS: Vertical incision through manubrium and sternum
              • Access to heart and anterior/prevascular mediastinum
                • Limited access to hila, lungs, pleura
              • Indications
                • Cardiac and aortic surgery
                  • Coronary artery bypass graft (CABG) most common
                  • Ascending aortic aneurysm or dissection
                  • Cardiac valve repair or replacement
                • Chest trauma exploration
                • Pulmonary embolectomy
                • Resection of anterior/prevascular mediastinal mass
                • Double lung transplant in some cases
              • Closure with cerclage or "figure 8" steel sutures
                • 2-3 wires in manubrium, 4-5 in sternum body
                • Heals quickly with stable closure and minimal pain
              • Stainless-steel wire sutures: Single wire, double wire, figure-of-eight, Robicsek weave
              • Other
                • Sternal bands
                • Polymer cable ties
                • Sternal plates
                  • Transverse rigid sternal plate fixation: May improve outcomes in patients at high risk for dehiscence, such as morbidly obese patients
            • CS: Broad transverse incision across sternum and 4th anterior intercostal spaces
              • Excellent access to heart and both hemithoraces
                • Disrupts sternal pericardial attachments
                  • Pleural spaces may communicate anteriorly
                  • Chest tube may cross midline anteriorly
                • Indications
                  • Double lung or heart-lung transplantation
                  • Resection of large mediastinal or cardiac mass
                  • Resection of bilateral lung metastases (rare)
              • Closure with steel "figure 8" sternal sutures
                • Extensive disruption of chest wall musculature
                • Increased risk of sternal complications

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • Imaging Recommendations

                  CLINICAL ISSUES

                  • Presentation

                    • Natural History & Prognosis

                      • Treatment

                        DIAGNOSTIC CHECKLIST

                        • Consider

                          • Image Interpretation Pearls

                            Selected References

                            1. Madjarov JM et al: Median sternotomy after sternal reconstruction with bilateral longitudinal plating in a patient with osteoporosis. Heart Surg Forum. 23(1):E058-60, 2020
                            2. Shudo Y et al: Impact of surgical approach in double lung transplantation: median sternotomy vs clamshell thoracotomy. Transplant Proc. 52(1):321-5, 2020
                            3. Cataneo DC et al: New sternal closure methods versus the standard closure method: systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 28(3):432-40, 2019
                            4. Foldyna B et al: Computed tomography improves the differentiation of infectious mediastinitis from normal postoperative changes after sternotomy in cardiac surgery. Eur Radiol. 29(6):2949-57, 2019
                            5. Nenna A et al: Sternal wound closure in the current era: the need of a tailored approach. Gen Thorac Cardiovasc Surg. 67(11):907-16, 2019
                            6. Valente T et al: MDCT prior to median re-sternotomy in cardiovascular surgery: our experiences, infrequent findings and the crucial role of radiological report. Br J Radiol. 92(1101):20170980, 2019
                            7. Wang B et al: Analysis of sternal healing after median sternotomy in low risk patients at midterm follow-up: retrospective cohort study from two centres. J Cardiothorac Surg. 14(1):193, 2019
                            8. Allen KB et al: Sternotomy closure using rigid plate fixation: a paradigm shift from wire cerclage. Ann Cardiothorac Surg. 7(5):611-20, 2018
                            9. Losanoff JE et al: Primary closure of median sternotomy: techniques and principles. Cardiovasc Surg. 10(2):102-10, 2002
                            10. Macchiarini P et al: Clamshell or sternotomy for double lung or heart-lung transplantation? Eur J Cardiothorac Surg. 15(3):333-9, 1999
                            11. Bains MS et al: The clamshell incision: an improved approach to bilateral pulmonary and mediastinal tumor. Ann Thorac Surg. 58(1):30-2; discussion 33, 1994
                            Related Anatomy
                            Loading...
                            Related Differential Diagnoses
                            Loading...
                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Imaging

                                • Clinical Issues

                                  • Diagnostic Checklist

                                    TERMINOLOGY

                                    • Abbreviations

                                      • Median sternotomy (MS)
                                      • Clamshell sternotomy (CS)
                                    • Synonyms

                                      • CS: Transverse sternotomy, cross-bow incision
                                    • Definitions

                                      • MS: Vertical incision through manubrium and sternum
                                        • Access to heart and anterior/prevascular mediastinum
                                          • Limited access to hila, lungs, pleura
                                        • Indications
                                          • Cardiac and aortic surgery
                                            • Coronary artery bypass graft (CABG) most common
                                            • Ascending aortic aneurysm or dissection
                                            • Cardiac valve repair or replacement
                                          • Chest trauma exploration
                                          • Pulmonary embolectomy
                                          • Resection of anterior/prevascular mediastinal mass
                                          • Double lung transplant in some cases
                                        • Closure with cerclage or "figure 8" steel sutures
                                          • 2-3 wires in manubrium, 4-5 in sternum body
                                          • Heals quickly with stable closure and minimal pain
                                        • Stainless-steel wire sutures: Single wire, double wire, figure-of-eight, Robicsek weave
                                        • Other
                                          • Sternal bands
                                          • Polymer cable ties
                                          • Sternal plates
                                            • Transverse rigid sternal plate fixation: May improve outcomes in patients at high risk for dehiscence, such as morbidly obese patients
                                      • CS: Broad transverse incision across sternum and 4th anterior intercostal spaces
                                        • Excellent access to heart and both hemithoraces
                                          • Disrupts sternal pericardial attachments
                                            • Pleural spaces may communicate anteriorly
                                            • Chest tube may cross midline anteriorly
                                          • Indications
                                            • Double lung or heart-lung transplantation
                                            • Resection of large mediastinal or cardiac mass
                                            • Resection of bilateral lung metastases (rare)
                                        • Closure with steel "figure 8" sternal sutures
                                          • Extensive disruption of chest wall musculature
                                          • Increased risk of sternal complications

                                    IMAGING

                                    • General Features

                                      • Radiographic Findings

                                        • CT Findings

                                          • Imaging Recommendations

                                            CLINICAL ISSUES

                                            • Presentation

                                              • Natural History & Prognosis

                                                • Treatment

                                                  DIAGNOSTIC CHECKLIST

                                                  • Consider

                                                    • Image Interpretation Pearls

                                                      Selected References

                                                      1. Madjarov JM et al: Median sternotomy after sternal reconstruction with bilateral longitudinal plating in a patient with osteoporosis. Heart Surg Forum. 23(1):E058-60, 2020
                                                      2. Shudo Y et al: Impact of surgical approach in double lung transplantation: median sternotomy vs clamshell thoracotomy. Transplant Proc. 52(1):321-5, 2020
                                                      3. Cataneo DC et al: New sternal closure methods versus the standard closure method: systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 28(3):432-40, 2019
                                                      4. Foldyna B et al: Computed tomography improves the differentiation of infectious mediastinitis from normal postoperative changes after sternotomy in cardiac surgery. Eur Radiol. 29(6):2949-57, 2019
                                                      5. Nenna A et al: Sternal wound closure in the current era: the need of a tailored approach. Gen Thorac Cardiovasc Surg. 67(11):907-16, 2019
                                                      6. Valente T et al: MDCT prior to median re-sternotomy in cardiovascular surgery: our experiences, infrequent findings and the crucial role of radiological report. Br J Radiol. 92(1101):20170980, 2019
                                                      7. Wang B et al: Analysis of sternal healing after median sternotomy in low risk patients at midterm follow-up: retrospective cohort study from two centres. J Cardiothorac Surg. 14(1):193, 2019
                                                      8. Allen KB et al: Sternotomy closure using rigid plate fixation: a paradigm shift from wire cerclage. Ann Cardiothorac Surg. 7(5):611-20, 2018
                                                      9. Losanoff JE et al: Primary closure of median sternotomy: techniques and principles. Cardiovasc Surg. 10(2):102-10, 2002
                                                      10. Macchiarini P et al: Clamshell or sternotomy for double lung or heart-lung transplantation? Eur J Cardiothorac Surg. 15(3):333-9, 1999
                                                      11. Bains MS et al: The clamshell incision: an improved approach to bilateral pulmonary and mediastinal tumor. Ann Thorac Surg. 58(1):30-2; discussion 33, 1994