[Operative technique of median sternotomy]

Median sternotomy is the most widely used incision in cardiac surgery. The skin incision should extend from just below the sternal notch to a few centimeters below the xiphoid process. Careful dissection behind sternal notch and xiphoid process should be required to prevent accidental adjacent vessels injuries. The sternotomy should be made on the midline of the sternum after detecting the lateral margin of the sternum by dipping the thumb and the index finger into the intercostal space. Off-midline sternotomy may cause the closure wires to cut through the thinner segment of the bone, which may cause wound infection. There has been an increase in the number of patients who undergo a 2nd or even a 3rd time cardiac surgery. Redo sternotomy is becoming a major technique in cardiac surgery. The sternum could be divided with an oscillating saw safely by lifting previous wires untwisted, which helps prevent possible right ventricular injury. Blunt digital manipulation or dissection can often result in tearing of the right ventricular wall which can be fatal.