Irishikesh Santhosh
Sternotomy:
- Identify landmarks
- Midline approximated by feeling costal cartilage on each side.
- Jugular notch and xiphoid should be identified as the superior and inferior points respectively.
- Incision single midline incision from the jugular notch to the xiphoid
https://lh7-rt.googleusercontent.com/docsz/AD_4nXc57RRLn6cbmXpxyXstbRwohom_GjbX2AMrGsjg_aNiv1h4X_aJti01sVG-PJWFl9ZvDtBeUXjigQnsO-WMukt88hns6MRHOkX1v75KJ6Pyd7IrpRymiSTUHl6smYTmln0lAOHn_A?key=TmrLySAiBWQ33M50DLF1jASA
- Subcutaneous dissection with scalpel till we reach peristernum.
- Carefully visualize the avascular plane between muscles to ensure you are on the midline
- Prepare the jugular notch and use the finger to retract the soft tissue.
- Divide the interclavicular ligament and slip a finger under the sternum.
https://lh7-rt.googleusercontent.com/docsz/AD_4nXfe4PHnU2hTSc_Jo3lEtmVfSPxeNRexgIVb-xo9GBG7nWT3noXO7iyiYjZqUE8cxdoW_qfHkX0WXjnnf4F1gkzF6cG1MxWgb2QMfg9nxllG2w6vy-yNiFb0m2endIItm2rLvhNL?key=TmrLySAiBWQ33M50DLF1jASA
- Prepare the xiphisternum, divide linea alba and use straight mayo to split the cartilaginous portion of the xiphoid. Slip finger under the sternum here as well.
https://lh7-rt.googleusercontent.com/docsz/AD_4nXfNR4AeVL0G2HWRXTA7Dn061X67DiCNNMrUi0yZ-Ywfk15Yzznfc7d1Ns0JJGhIgYfBGw22RnYifgCgPphb_h__4V1onHaAWiVkf6DcyvXyJgBO2lLNuWby8tCgPJf3VLityzLp?key=TmrLySAiBWQ33M50DLF1jASA
- Using an oscillating saw from the bottom-up or the other way around in a single motion.
- Always pull the saw upwards to avoid injury to underlying structures.
https://lh7-rt.googleusercontent.com/docsz/AD_4nXf_QWLegx3VJISMlFbTbI3zcgAYOwsr919vGoWEdKJpbtGBCufxsnx8Hi7MvlK71suGplvgTVuEA3Aa-Fkr7egf6_CwTa6-AkLUyqe61W0K9cC5ZViUHmODkg0rIfNB5ACKijF4jA?key=TmrLySAiBWQ33M50DLF1jASA
- Change gloves to avoid introducing cutaneous germs into the mediastinum. This step can be avoided to save time.
- Retractor placed not too cranially to avoid innominate vein and brachial plexus tension or damage.