Irishikesh Santhosh

Sternotomy:

1. 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.

1. Incision single midline incision from the jugular notch to the xiphoid

1. Subcutaneous dissection with scalpel till we reach peristernum.
2. Carefully visualize the avascular plane between muscles to ensure you are on the midline
3. Prepare the jugular notch and use the finger to retract the soft tissue.
4. Divide the interclavicular ligament and slip a finger under the sternum.

1. 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.

1. Using an oscillating saw from the bottom-up or the other way around in a single motion.
2. Always pull the saw upwards to avoid injury to underlying structures.

1. Change gloves to avoid introducing cutaneous germs into the mediastinum. This step can be avoided to save time.
2. Retractor placed not too cranially to avoid innominate vein and brachial plexus tension or damage.