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Reconstruction of the Anterior Mediastinum After Median Sternotomy

Hilary H. Timmis, MD
Arch Surg. 1968;97(5):736-738. doi:10.1001/archsurg.1968.01340050076009.
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WHILE MEDIAN sternotomy is routinely used as the optimal approach for the repair of many cardiac defects, postoperative drainage even when the pericardium is left widely open may be less than adequate.1 Consequently, the correction of certain lesions which seem predisposed to more than the usual blood loss after apparent restoration of the clotting mechanism and adequate hemostasis, are managed by also opening the pleural reflection on the right side. This allows for continuous decompression of the pericardial cavity into the right pleural cavity. However, the potential for troublesome postoperative bleeding from the anterior mediastinum, and particularly from sternal fractures produced during adequate exposure of the heart through the median sternotomy approach, is sometimes not ap preciated and may be overlooked at the time of wound closure. The tendency for bleeding to persist from retrosternal tissue planes is compounded by the continuous motion of the heart when the pericardium


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