Simple and safe redo sternotomy technique using the ultrasonic bone scalpel for patients with an embedded calcified conduit.

With the increase of patients with adult congenital heart disease, the number of high-risk multiple redo sternotomies is increasing. Calcified conduit embedded in the sternum or large vessels attached to the sternum presents an especially challenging case. This video tutorial presents a simple safe redo sternotomy technique using an ultrasonic bone scalpel in such high-risk patients. The ultrasonic bone scalpel has a narrow cutting blade that oscillates longitudinally. Because the movements of the blade have a much smaller amplitude and faster speed than those of the usual saw, making a precise cut is possible when holding the ultrasonic bone scalpel onto the bone, and soft tissue can be dissected out with a quick touch. A narrow blade can shave the sternum on the conduit when the layer between the sternum is identified. A lack of understanding of the character of the ultrasonic bone scalpel often limits its potential. This video tutorial demonstrates the key techniques of the fine manipulation of the blade: "hold-quick touch-shave" for the effective and safe use of an ultrasonic bone scalpel.