Redo Submammary Incision for Median Sternotomy and Cardiac Repair

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Redo Submammary Incision for Median Sternotomy and Cardiac Repair Jonah Odim, MD, PhD, Raj Vyas, BS, Hillel Laks, MD, Azie Alikhani, BA, Umang Mehta, MD, Kakra Hughes, MD The Annals of Thoracic Surgery Volume 79, Issue 1, Pages 163-167 (January 2005) DOI: 10.1016/j.athoracsur.2004.06.116 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The schema for the transverse submammary skin incision is shown with underlying median sternotomy. The extent of dissection of the superior (upper) and inferior (lower) flaps is demarcated by the shaded areas. The Annals of Thoracic Surgery 2005 79, 163-167DOI: (10.1016/j.athoracsur.2004.06.116) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Primary incision was made before breast development. Redo incision was made 11.6 years later. In this patient, the redo incision was made slightly below the original, making sure to follow the contour of the developed breast and avoiding entry into the breast tissue. (B) The incision is made down to the fascia, and skin flaps are elevated superiorly and inferiorly. The sternum is carefully opened vertically and in the midline with an oscillating saw. Beware of injuring the skin flaps during this maneuver. (C) This 14-year-old girl, with l-transposition of the great arteries and dextrocardia, is undergoing replacement of a left ventricle–to–pulmonary artery conduit. The malleable retractor, which is attached to the crossbar of the sternal retractor, is shown retracting the upper skin flap, which is protected by a moist pad. Exposure of the upper ascending aorta is adequate. The aortic perfusion cannula is also shown. (D) The chest tube exit sites are placed laterally, below the level of incision. The tracts of the chest tubes pass parallel to the linea alba and are outside the space beneath the flaps. (E) A small Hemovac drain is left in the space beneath the flaps and brought out lateral to the incision. The subcutaneous fascia is closed with interrupted sutures, and the skin is closed either with a subcuticular suture or a running fine nylon suture. (F) The patient was discharged from hospital with this cosmetic result. The Annals of Thoracic Surgery 2005 79, 163-167DOI: (10.1016/j.athoracsur.2004.06.116) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions