Name of the Procedure:

Closure of Median Sternotomy Separation with or without Debridement

• Common Names: Sternotomy Closure, Sternum Repair
• Technical Terms: Median Sternotomy Closure, Sternum Reapproximation, Sternal Debridement

Summary

Closure of a median sternotomy separation is a surgical procedure used to repair the breastbone (sternum) after it has been intentionally split during previous surgeries, such as open-heart surgery. The procedure may involve cleaning (debridement) of infected or dead tissue as needed.

Purpose

• Medical Condition: Separation or instability of the sternum following initial surgery.
• Goals: To stabilize the sternum, promote proper healing, reduce pain, avoid infection, and restore normal chest function.

Indications

• Symptoms of chest pain or instability.
• Evidence of sternal separation or infection from imaging studies.
• Non-healing or delayed healing of the sternum after cardiac surgery.
• Recurrent or chronic sternal infections.

Preparation

• Pre-procedure Instructions: Patients may need to fast for several hours before the surgery and stop certain medications, especially blood thinners.
• Diagnostic Tests: Chest X-ray, CT scan, or MRI to confirm the condition. Blood tests to assess overall health and detect infection.

Procedure Description

1. Patient is anesthetized—general anesthesia is used.
2. Surgeon makes an incision along the previous sternotomy scar.
3. If debridement is necessary, infected or necrotic tissue is carefully removed.
4. The separated halves of the sternum are brought together using surgical wires, plates, or other fixation devices.
5. The wound is closed with sutures or staples.
6. Drain(s) may be placed to remove excess fluids.
7. A sterile dressing is applied.

Duration

The procedure typically takes 2-4 hours, depending on the complexity and extent of debridement required.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Possibly other supporting staff (e.g., surgical technicians)

Risks and Complications

• Infection
• Bleeding
• Non-union or re-separation of the sternum
• Pain at the surgical site
• Adverse reactions to anesthesia
• Risks associated with comorbidities

Benefits

• Stabilized sternum and restored chest function.
• Relief from pain and discomfort.
• Reduced risk of complications from sternal separation or infection.
• Improved overall recovery from initial surgery.

Recovery

• Post-procedure Care: Hospital stay of a few days for monitoring. Pain management with medications. Wound care and possible drains management.
• Expected Recovery Time: Typically, full recovery may take 6-8 weeks.
• Restrictions: Avoid heavy lifting, strenuous activities, and driving until permitted by the surgeon.
• Follow-up Appointments: Regular check-ups to monitor healing and address any complications.

Alternatives

• Non-Surgical: Intensive physical therapy, bracing or external fixation.
• Surgical: In some cases, less invasive procedures may be considered.
• Pros and Cons: Alternatives may offer less invasive options but might not provide the same level of stabilization and could carry their own risks and limitations.

Patient Experience

Patients may experience pain and soreness around the incision site, managed by pain medications. Some discomfort is expected, but significant improvement is generally felt within a few days to weeks. Restrictions on activity are essential for proper healing, and following all post-operative instructions will enhance recovery and decrease complications.