Special hospital
FILIP VTORI
Phone: +389 2 3091- 484 www.cardiosurgery.com.mk
Ste r n o to m y
Dear patients Median sternotomy is a type of surgical procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided, and access to the heart is provided. Six to nine weeks are needed for cicatrisation of the sternum.
Although the general risk of sternal complications (destabilization, dehiscence, infection) is low (les than 1%), there are certain factors that may affect the cicatrisation process of the sternum and the surgical wounds:
Primary risk factors for sternal complications Personal hygiene. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Obesity –BMI > 35 (body weight and height ratio) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Smoking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chronic obstructive pulmonary disease (COPD). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Peripheral vascular disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Female (large breasts) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Prolonged duration of surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Re-surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Secondary risk factors for sternal complications Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Extended stay in the intensive care unit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Long-term antibiotics use - preoperative. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Urgent surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Septic shock. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
After cardiovascular surgery, it is very important for your recovery to learn how to gradually and safely return to your every-day activities. For faster wound healing and lowering the risk of complications, follow these Precautionary measures cardiovascular surgery:
after
• Do not forcibly push or pull with your hands (for ex. do not lean on your hands when standing up from a chair, do not open heavy doors) • Do not lift more than 2-3 kg of weight • Do not lift one of your hands above the head (both hands may be lifted simultaneously) • Do not reach with your hands backwards (for ex. to put a wallet in your pocket) • Organize your day evenly with activities and rest • Take a rest after a meal before you exercise or do other fatiguing activities. This will give you enough time for digestion of the food and lower your heart load • Avoid excessive heat or cold
• Regular every-day shower with soap and water • Wearing a bra is of extreme importance in females When to see your doctor • Your body temperature is higher than 38.5°C • Enhanced flushing, sensitivity or drainage from surgical wounds • Abundant wound drainage If dressings and treatment of the surgical wounds is necessary, it should be done in the ambulance: two dressings after the surgery are free, and each of the following will be recouped by the patient. I declare that I am aware of the possible complications for the surgical wounds and I agree to pay all expenses in case there is a need for more than 2 dressings postoperatively.