When a doctor tells you or someone you know that you need to have open heart surgery, one of the biggest fears that comes to mind is, "Will my chest be opened?" What actually happens in this? The medical term for this "opening of the chest" is "Sternotomy." Don't be scared when you hear this name, it's not as scary as you think. Let's talk about everything very simply, from A to Z.
Simply put, what is Sternotomy?
A sternotomy is a procedure that temporarily separates the flat bone in the middle of your chest, the sternum (breastbone), for surgery. Think of it this way: the sternum and ribs are there to protect vital organs like the heart and lungs inside our chest. It's like a safe that holds valuables.
So, when a heart problem (such as a blocked blood vessel leading to the heart) needs to be corrected surgically, the surgeon needs to have good access to the heart. At that time, this protective breastbone is carefully cut down the middle and then split in two to create a path to the heart. This is called a `Sternotomy`.
Just like a door frame is temporarily removed and then reattached to allow a large item to enter a house, this breastbone is temporarily separated in two and then reattached after surgery to allow surgeons to easily reach your heart.
Sometimes, instead of completely cutting the sternum, a smaller incision (about 2-3 inches) is made. This is called a `mini-sternotomy`.
Is a sternotomy a major surgery?
Yes, this is considered a major surgery. The main reason is that it takes about 8 weeks, or about two months, for the sternum to fully heal. Also, a sternotomy is usually performed as an open heart surgery, which means it prepares the way for a major surgery like open heart surgery, so when you take both of these surgeries together, it becomes a major surgery. But remember, this is a very common and successful surgery performed by cardiac surgeons all over the world.
How is the surgery performed? Step by step
It's normal to feel scared when thinking about a surgery like this. But that fear is greatly reduced when you know exactly what's going to happen. Here's how the surgery is performed step by step.
| Steps | What is happening? |
|---|---|
| 1. Preparation | You will be fully anesthetized, so you won't feel any pain. Then, the skin on your chest will be thoroughly cleaned and hair removed if necessary. |
| 2. Skin incision | The surgeon will make a 6-inch incision in the skin of your chest, from between your collarbones down. |
| 3. Sternum incision | Using a special medical saw (`sternal saw`), the breastbone is very carefully and accurately divided in two down the middle. |
| 4. Making space for the heart | A special device (a ``retractor'') is inserted and the two separated bone fragments are moved to the sides, creating space so that the heart can be clearly seen. |
| 5. Performing major surgery | This is when surgery on the heart or related organ (e.g., bypass surgery, valve replacement) is performed. |
| 6. Reattachment of the sternum | Once the surgery is complete, the separated sternum is put back together and secured with about 8 to 12 stainless steel wires (sternotomy wires). |
| 7. Stitching the wound | Finally, the internal tissues and skin are sutured, the wound is closed, and an ointment is applied to prevent infection. |
What to expect after surgery?
After the surgery, you will need to stay in the hospital's intensive care unit (ICU) for a few days. Then you will be transferred to a regular ward.
Recovery time and things to be aware of
- Healing time: It takes about two months for the sternum to fully heal. You need to be very careful during this time.
- Pain: It is normal to have some pain after surgery. However, most people can manage the pain with simple painkillers such as `Paracetamol`. If you have unbearable pain, tell your doctor or nurse.
- Lifting weights: This is very important . In the first two months, do not lift more than 4-5 kg . Simply put, it is not good to lift more than 4-5 liters of milk.
- How to use your hands: When lifting something, use both hands. Also, lift with both hands close to your body. Avoid lifting weights with one hand or pushing doors.
- Coughing and sneezing: When coughing, sneezing, or laughing, place a pillow or a folded arm against your chest. This will reduce the pressure on your sternum and reduce pain.
- Driving: You will usually be able to drive again in about a month or two, but it is best to check with your doctor to make sure.
Warning signs that you should see a doctor
After you go home, it's very important to pay attention to your wound and your body. If you have any of the following symptoms, call your doctor immediately , or go to the hospital where you received treatment.
- Breastbone changes: If you feel like your breastbone is moving, or if you hear or feel a 'click' or 'click' sound.
- Increasing pain: The pain should gradually decrease as the wound heals. But if the pain suddenly increases.
- Wound drainage: If the wound is oozing yellow, green, or foul-smelling pus-like fluid.
- Swelling and redness: If the area around the wound is very red, swollen, and feels hot to the touch.
- Fever: If there is a fever in the body.
These symptoms may indicate that the wound is infected or the bone is not healing properly. So don't ignore them.
Take-Home Message
- A sternotomy is a very common and safe procedure used to make room for heart surgery. Don't be afraid of it.
- It takes about two months for a severed sternum to heal. During this time, avoid lifting heavy objects or straining your body in any way.
- Follow your doctor's instructions carefully, especially regarding lifting weights and protecting your chest.
- If the wound becomes painful, makes an unusual noise, or has symptoms such as pus draining from it, seek medical advice immediately.
- If you have any questions about this surgery, don't be afraid to ask your surgeon. It's your right.
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