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Ann Thorac Surg 2005;79:e19-e20
© 2005 The Society of Thoracic Surgeons

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How to do it

Sternal Approximation for Bilateral Anterolateral Transsternal Thoracotomy for Lung Transplantation

^a Division of Cardiovascular and Thoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
^b Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
^c Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama

Accepted for publication September 19, 2004.

^* Address reprint requests to Dr McGiffin, University of Alabama at Birmingham, Division of Cardiothoracic Surgery, 701 19th St S, LHRB 780, Birmingham, AL 35294-0007 (E-mail: david.mcgiffin{at}ccc.uab.edu).

The traditional incision for bilateral sequential lung transplantation is the bilateral anterolateral transsternal thoracotomy with approximation of the sternal fragments with interrupted stainless steel wire loops; this technique may be associated with an unacceptable incidence of postoperative sternal disruption causing chronic pain and deformity. Approximation of the sternal ends was achieved with peristernal cables that passed behind the sternum two intercostal spaces above and below the sternal division, which were then passed through metal sleeves in front of the sternum, the cables tensioned, and the sleeves then crimped. Forty-seven patients underwent sternal closure with this method, and satisfactory bone union occurred in all patients. Six patients underwent removal of the peristernal cables: 1 for infection (with satisfactory bone union after the removal of the cables), 3 for cosmetic reasons, 1 during the performance of a median sternotomy for an aortic valve replacement, and 1 in a patient who requested removal before commencing participation in football. This technique of peristernal cable approximation of sternal ends has successfully eliminated the problem of sternal disruption associated with this incision and is a useful alternative for preventing this complication after bilateral lung transplantation.

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