A minimal transverse incision with low median sternotomy for pediatric congenital heart surgery

Objectives: Median sternotomy is the incision of choice for most cardiac su rgical procedures, but the full-length vertical skin incision generally lea ves an unsightly scar. In certain patients undergoing short, low-risk proce dures, cosmetic considerations are of relatively greater importance. Method s: A minimal transverse curvilinear skin incision with low median sternotom y is described which gives adequate exposure for selected open-heart proced ures. Since September 1997, this approach has been used in 22 pediatric pat ients undergoing open-heart surgery including five cases of Fallot's tetral ogy. We also compared the operation time and result with other approaches. Results: Using this modified method, the exposure of the heart was good eno ugh, and there were no difficulties in cannulating the ascending aorta for cardiopulmonary bypass. Although it took a longer time to close the wound, the operation time was similar to the standard approach. The small transver se wound was not visible under conventional clothes. Conclusions: A minimal transverse incision with low median sternotomy provides an alternative app roach for small wound open-heart surgery in patients with a simple congenit al cardiac defect. It is technically feasible and has a good cosmetic resul t. (C) 2001 Elsevier Science B.V. All rights reserved.