Surgical Access to the Heart
Median Sternotomy
- Incision from suprasternal notch to lower end of xiphisternum
- Sternum covered by fat + pectoral muscles
- Superiorly: Suprasternal ligament from SCJ to other
- Inferiorly: rectus abdominis fibres
- Sternum divided + retracted
- Superiorly:Thymus
- Inferiorly: Pericardium
- Thymus divided in midline
- Highly vascular
- Care because lies anterior to innominate/brachiocephalic vein
- Pleura dissected from pericardium laterally
- Pericardium opened +/- cannulation (with full heparisation)
Closure of Sternotomy
- Ensure haemostasis
- Insert pairs of stainless steel wires (usually 6) through sternal body
- Inspect for bleeding from internal thoracic vein/artery
- Twist wires
- Cross wires
- Suture fascia to pectoral fibres
- Close skin with subcuticular stitch
