The management of severe adherence of mediastinal structures to the sternum during cardiac reoperations.

The author's method for sternal re-entry in cases of extremely dense mediastinal adhesions is described. The anterior lamina and the spongiosa of the sternum is cut with an osteotome and the posterior lamina is divided using the Lebsche knife so as to leave the densely adhered patch of the posterior lamina on the underlying soft tissue. These bone fragments may be left in loco or, if the course of the operation requires it, they may be gently raised and peeled off. Removal of such a portion or portions of the posterior lamina does not appreciably weaken the sternum and safe sternal closure may be accomplished without difficulty.