Thoracic Surgery – Information for patients: Having surgery via median sternotomy

What is a median sternotomy?

Median sternotomy is a surgical approach allowing surgeons to gain access to the structures within the chest cavity and perform specialist procedures on the lungs, the heart, the major blood vessels or the thymus gland. These procedures are always performed under general anaesthesia by a specialist team of thoracic surgeons and anaesthetists. You may need to have a median sternotomy if you require surgery on the thymus gland, the windpipe (trachea), the smaller airways (bronchi), the blood vessels inside the chest cavity or on the heart.

What happens during median sternotomy?

Your surgeon will make a vertical incision down the midline of the chest, and the breastbone (sternum) will be cut to open the chest. The necessary surgical procedure will then be carried out inside the chest. At the end of the procedure, the two halves of the sternum will be ‘sewn’ back together with a titanium wire. The internal wires around your breastbone will remain there permanently and do not have to be removed. The skin incision will be closed with sutures or staples.

Will I have a chest drain?

During your procedure, the surgeon may place one or more chest drain(s), normally located in the centre of the chest. Their aim is to drain any extra air, fluid or blood that might collect in the chest. The drain(s) will normally remain in place for 24-48 hours after your operation, or occasionally longer, depending on the amount of drainage of blood, fluid or air present. The nurses and doctors will frequently monitor your drains and inform you of the plan regarding their removal. You may also have a chest Xray.

What will my recovery look like after median sternotomy?

It takes approximately 12 weeks for the sternum to fully heal. During your hospital admission, our team of surgeons, nurses and physiotherapists will advise and demonstrate to you the safest ways to reposition in bed, mobilise and exercise after your surgery. During your recovery period, we also advise you to consider the following dos and don’ts.

We advise you that you do:

• Continue with light exercise, walking and deep breathing.
• Continue with light housework, light gardening and social activities as your energy levels allow you to.
• From the first post-operative day onwards, female patients are advised to wear a non-wired bra.
• Rest when you feel tired and try sleeping on your back until your chest has healed.
• Try holding a pillow against your chest when you cough to support your sternum and reduce the pain.
• Resume sexual activity when you feel able to. Try and find a position that is comfortable and best supports your sternum and wound.
• Listen for any clicking sounds on moving. This is a sign that the sternal bones have not yet fully fused. Please call us if this persists.
• Look for any changes in the shape of your chest and inform your clinical team if you notice anything unusual.
• Be careful when walking your dog and holding the leash in one hand and avoid doing this unaccompanied in the first 6 weeks after surgery.
• Wear loose comfortable clothing and secure footwear.
• Use a seatbelt when travelling by car. You can make this more comfortable by using a pillow or towel between your chest and seatbelt.

We advise you that you do not:

• Do anything strenuous, especially activities that will strain your chest, shoulders and upper arm muscles.
• Carry children or do any heavy lifting. In the first 6 weeks you should not carry anything heavier than a kettle half-full of water. After 6 weeks, you can gradually increase the weight you can lift.
• Pull yourself up or push yourself out of bed using one arm. Instead, use a side- rolling technique to get out of bed.
• Push heavy doors with one hand or pull yourself upstairs using the banister. Instead, try to use both arms equally with all tasks for the first 6 weeks.
• Return to work immediately. Please consider allowing for up to 8 weeks off if your job involves light work and 12 weeks off for heavy, physical work.
• Drive for 6 weeks. Be sure to let your insurance company know that you have had surgery on your chest.
• Fly for 6-8 weeks as you are at an increased risk of blood clots (DVT) after surgery. Inform your travel insurance that you have had surgery.

For more information and advice about your thoracic procedure, your hospital stay, the thoracic team and our enhanced recovery programme, please see our Thoracic Surgery Patient Booklet and Patient Diary. You can get in touch by calling us on 0203 456 6047 or by emailing us at uclh.ThoracicSurgeryCNS@nhs.net