Page 150 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 11 · Thoracic wall anatomy and surgical approaches

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(c) (d)

(e) (f)

(g) (h)
(continued) The steps involved in performing a median
11.5
sternotomy. (c) An oscillating saw is used to perform the median
sternotomy along the ventral midline of the sternum. Care should be taken
to avoid iatrogenic damage to the underlying lungs and heart during the
median sternotomy by limiting penetration of the saw blade. (d) In this dog,
a median sternotomy has been performed to allow resection of a cranial
mediastinal thymoma (TH). The edges of the intercostal thoracotomy are
protected with moistened laparotomy sponges (LS) and the ribs are
retracted with Finochietto rib retractors (FRR) to maximize exposure of the
thoracic cavity. e The median sternotomy can be closed ith a figure-of-
eight suture pattern using heavy-gauge suture material (5 metric (2 USP)
polypropylene). Suture closure of the median sternotomy should only be
performed in cats and small dogs, because suture closure in larger breeds
of dogs results in inferior sternal stability and osseous healing of the median
sternotomy when compared with wire closure (Pelsue et al., 2002).
(f) Alternatively, the median sternotomy can be closed with orthopaedic
ire in this case an individual cruciate pattern across each costosternal
junction is used. (g) The wires are preplaced and then tightened.
(h) Following closure of the sternum, the pectoral muscles, subcutaneous
(i) tissue and skin are closed routinely. (i) The thoracostomy tube is secured
ith a Chinese fingertrap suture pattern.

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