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T-modification of sternotomy to accommodate a low-lying tracheostomy
Kenneth J Woodside1, Joseph B Zwischenberger, D Adrian Olvera
1Division of Cardiothoracic Surgery, Department of Surgery, The University of Texas Medical Branch, Galveston, Texas, USA.
The Annals of Thoracic Surgery
|March 3, 2004
Summary
A modified surgical approach can prevent injury to low-lying tracheostomies during sternotomy for coronary artery bypass grafting. This technique preserves sternoclavicular joint integrity, ensuring patient safety.
Area of Science:
- Cardiothoracic Surgery
- Anatomical Surgical Approaches
Background:
- Low-lying tracheostomies pose a significant risk during sternotomy for coronary artery bypass grafting (CABG).
- Standard sternotomy techniques can lead to inadvertent injury to the tracheostomy site.
Purpose of the Study:
- To present a modified surgical technique for sternotomy in patients with low-lying tracheostomies.
- To describe a method that avoids injury to the tracheostomy and preserves sternoclavicular joint anatomy.
Main Methods:
- A modified "T"-shaped sternal exposure is described.
- The manubrium is transected at the level of the first intercostal space.
- This approach facilitates sternotomy while protecting the anterior neck structures.
Main Results:
- The modified approach successfully avoids injury to tracheostomies located at or below the sternal notch.
- Sternoclavicular architecture is maintained, preventing complications associated with joint disruption.
- The technique allows for safe performance of coronary artery bypass grafting.
Conclusions:
- A modified "T" sternal exposure is a safe and effective technique for patients requiring coronary artery bypass grafting with a low-lying tracheostomy.
- This approach minimizes the risk of tracheostomy injury and maintains important anatomical structures.