Precautions Related to Midline Sternotomy in Cardiac Surgery: A Review of Mechanical Stress Factors Leading to Sternal Complications

Abstract

This study provides insights into mechanical stress factors acting upon sternum and the overlying skin. RECOMMENDATIONS on activity precautions based on these finding have a patient supportive approach focusing on possibilities and not restrictions.

The Sternal Management Accelerated Recovery Trial (S.M.A.R.T) – standard restrictive versus an intervention of modified sternal precautions following cardiac surgery via median sternotomy: study protocol for a randomised controlled trial

“…On the basis of these findings, restricting the use of the upper limbs and trunk in an attempt to prevent excessive sternal motion may be overly cautious. Sternal precautions in the form of physical restrictions may delay recovery, prolong return to function and delay hospital discharge, and as such may be overly restrictive [8, 18, 19]. …”

Low-Intensity Laser Therapy and Led (Light Emitting Diode) Therapy in Mechanical Resistance of Rattus Norvegicus Chest Inscision With Implant of Steel Wire for Sternal Suture

“…The infection can involve other structures surrounding the sternum causing sternal osteomyelitis or mediastinitis. This study analyzed the incidence of superficial wound infection, which according to Brocki et al (2010) affects between 1.6% and 6.4% individuals after surgery. In this study, 7.14% developed superficial infection.…”

Acute care physical therapy management of a 69-year-old female following re-operative aortic valve replacement and tricuspid valve repair: A Case Report

“…Since sternal disruption occurs in 2%-8% of patients with median sternotomy, therapeutic interventions were focused on instructing the patients receive providing instructions in sternal precautions including the appropriate transfer techniques from supine to sitting position, to rise from a chair using her legs rather than pushing down with the arms as this could add stress to the incision [14]. The patient was also instructed on hugging a pillow when coughing to help to brace the incision to reduce the disruptive forces on the incision [15]. Education was provided on importance of continued adherence to precautions after discharge to minimize sternal stress, pain and for improved healing.…”

“…Education was provided on importance of continued adherence to precautions after discharge to minimize sternal stress, pain and for improved healing. 15 Further education focused on education regarding posture correction, safety, fall prevention, RPE scale and integration to guide activity, signs and symptoms of exercise intolerance, safe exercise parameters, home exercise program and progression. Table 2 provides a summary of the main physical therapy interventions provided during the episode of care.…”