To the Editor:
The sternotomy is still a frequently used incision. The unstable, clicking sternum is unfortunately an occurrence following its use. The technique described here has reduced the incidence of unstable sternotomy in my practice. This technique was recommended by a patient who had a recent sternotomy. On his return visit, he brought a model to show me how I should make a sternotomy. (He's an orthopedic surgeon.) In place of the traditional straight cut (Fig. 1) of the sternum, a curved one (Fig. 2) is used. It results in interlocking and prevents vertical slipping of the 2 parts of the sternum. Simple wires are used for closure.
Fig. 1 Standard straight sternotomy
Fig. 2 Curved sternotomy
Since adopting this technique 2 years ago, I have seen only a rare patient with any sternal motion or clicking. The drawing is self-explanatory. A standard sternal saw is used.