What Is a Sternotomy?

Sternal turnover is a medical procedure.

Sternal turnover

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Sternal turnover is a medical procedure.

Chinese name

Sternal turnover

Foreign name

sternal turnover method

Sternal turnover

Sternal turnover method

Thoracic Surgery / Chest Wall Surgery / Surgical Treatment of Congenital Chest Wall Deformation / Funnel Chest Surgery / Funnel Chest Surgery / Chicken Breast Surgery / Chicken Breast Surgery

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Chicken breast is a deformity of the sternum protruding forward, which is more rare than the funnel breast, accounting for 16.7% of all chest wall deformities. According to the shape of rib cartilage and sternal anterior deformity, it is divided into four types: type I, symmetrical deformity, which is the most common type, accounting for 57.4%. The sternum and lower rib cartilage symmetrically protrude forward, and the lateral portion of the rib cartilage and the ribs are sunken inward. Type , asymmetric deformities, is rare, accounting for 31.6%. Appeared as one side costal cartilage forward, contralateral costal cartilage is normal or nearly normal. Type , mixed malformations of chicken breast and funnel breast, rare, accounting for 9.0%. Presented as one side costal cartilage protruding forward, contralateral depression or funnel chest deformity, often sternal spine. Type , deformity of the upper rib cartilage sternal stem, also known as convex breasted pigeon type, the least common, accounting for 1.9%. The 2nd to 3rd rib cartilage and sternal stem protrude forward, and the sternal body is depressed inward.

The cause is not very clear, and it is believed to be genetically related, because the breast wall deformity in the family, the incidence of chicken breasts increased significantly. 12% of chicken breasts with scoliosis had a family history. In half of the patients, malformations were only discovered after the age of 11; the other patients had mild deformities at birth, progressed in early childhood, and became more pronounced during puberty. Patients rarely have symptoms of cardiopulmonary compression, and some patients may have bronchial wheezing. Most patients are mentally burdened due to chest wall deformities.

In 1952, after Ravitch first reported the use of multiple rib cartilage resection and sternal osteotomy to correct a convex breasted chicken breast, several authors reported different surgical methods, such as cutting the xiphoid process and the rectus abdomen sternal attachment, The rectus abdominis muscle is re-fixed, and the rectus abdominis muscle is attached to a higher position of the sternum, so that the sternum is displaced backward. Later, some people proposed a costal cartilage subperiosteal resection of costal cartilage and sternum transverse wedge osteotomy. Recently, authors have tried plastic stent correction, which has been successful in young children. At present, the sternal turnover method and the sternal settlement method are more commonly used.

Chicken breasts and funnel breasts can be corrected with sterno-turnover with preservation of superior and inferior vascular supplies. However, the ribs and cartilage of chicken breasts are too long and different from the funnel chest. The upper ribs and rib cartilage are different. Longer, lower ribs and costal cartilage are relatively short, should pay attention to this feature when plastic surgery to remove excessively long costal cartilage. After the sternum is flipped, appropriate incisions, resections, or flattenings are performed according to the specific variations of the sternum stem, sternum body, and rib cartilage to obtain good correction results.

It is basically the same as the funnel chest, and those with significant deformities can be considered for orthopedic surgery. Due to milder symptoms, the age of surgery can be delayed compared to the funnel chest.

In addition to routine preoperative preparations, patients with chicken breasts often have bronchial wheezing or congenital heart malformations. Therefore, cardiopulmonary examinations should be taken seriously before surgery.

Intratracheal intubation with intravenous anesthesia. Supine position.

It is basically the same as the funnel chest "sternal flip method".