Anterior sternal retraction for reoperative median sternotomy

Direct-Vision Retrosternal Dissection Using the Kent Retractor for Sternal Re-Entry

“…Eddy et al 2 reported a significantly higher incidence of severe injuries to the heart or great vessels when the blind resternotomy technique was used than when the retrosternal direct-vision approach was used, at 6% versus 0%.…”

“…1,2 The previously reported safe and effective techniques for sternal re-entry 1-6 can be classified into two groups, namely, blind resternotomy and direct-vision sternal re-entry. The former involves repeat sternal division using an oscillating saw, followed by dissection of retrosternal adhesions, whereas the latter involves elevation of the sternum allowing direct-vision dissection of the retrosternal adhesions, followed by sternal splitting.…”

Plastron-Trapdoor Technique for Direct-Vision Sternal Re-entry

“…1 Safe and effective techniques for sternal re-entry are classified into two groups: blind resternotomy using an oscillating saw, 2 and directvision sternal re-entry involving elevation of the sternum to allow for direct-vision dissection of retrosternal adhesions. 3 However, the risk of catastrophic hemor- rhage is still as high as 1%, even though risks associated with direct-vision sternal re-entry are lower than the risks associated with blind resternotomy. 2,3 Repeat sternotomy is also a predictor for postoperative sternal infection, 4 with a reported risk of 0.6%.…”

“…3 However, the risk of catastrophic hemor- rhage is still as high as 1%, even though risks associated with direct-vision sternal re-entry are lower than the risks associated with blind resternotomy. 2,3 Repeat sternotomy is also a predictor for postoperative sternal infection, 4 with a reported risk of 0.6%. It has also been reported that major pectoralis muscle reconstruction or other muscle flaps need to be used to prevent infection.…”

Safe sternal reentry in all age groups with the Rultract Resternotomy Retractor™

“…These risks increase as the number of previous surgeries increase and are present regardless of age group or type of procedure . Multiple strategies for sternal reentry have been proposed . We have developed a technique for sternal reentry that is adaptable to both pediatric and adult congenital patients with the use of a retractor that was developed by Rultract Inc. (Cleveland, OH).…”