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A median sternotomy incision was employed in 73 cases of pulmonary surgery instead of posterolateral thoracotomy. An anterior mediastinal approach was used in three groups of patients: group 1 patients (47 cases) underwent simultaneous bilateral surgery for pulmonary disorders on both sides, in group 2 patients (15 cases), this approach was selected to facilitate surgery on the involved mediastinal structures, and group 3 patients (11 cases) had left lung cancer with extensive dissection of lymph nodes done via median sternotomy, as well as routine dissection of nodes by posterolateral thoracotomy. A median sternotomy approach for pulmonary surgery provided an excellent operative field, and most patients experienced less postoperative pain and a quicker recovery. The surgical indications for this approach, the surgical procedure, the results, and the advantages and disadvantages of using a median sternotomy incision are discussed.

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.1Consequently, 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

A median sternotomy approach was used for closure of patent ductus arteriosus associated with a hypoplastic right lung. The anterior approach to the left ductus is indicated if left thoracotomy is contraindicated.