FIGURE 2. The xiphoid and the lowermost 2 perichondrial sheaths are detached from the lower sternum. The retrosternal space is mobilized over a distance of 4 to 5 cm. A small chest tube is placed into the right pleural space for drainage in most patients. A transverse wedge osteotomy is made across the anterior table of the sternum at the desired level. The posterior table of the sternum is fractured but not detached, and the lower sternum is elevated to the desired level.