title: Modified sternotomy to minimize infection risk in patients with prior laryngectomy and permanent tracheostomy.
abstract: Patients with prior laryngectomy and permanent tracheostomy undergoing complete sternotomy historically are at increased risk for wound infection, osteomyelitis, mediastinitis, bleeding, tracheal injury, and poor wound healing. We describe three patients who underwent cardiac surgery via low midline incision with transverse flap, providing the exposure of complete sternotomy and decreased infectious risk. Patient selection, technique, and management principles are discussed.
authors.affiliation: General Surgery Service, Madigan Army Medical Center, Tacoma, Washington 98431, USA.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Mullenix
authors.forename: Jerome M
authors.initials: JM
authors.lastname: McDonald
authors.forename: Joseph
authors.initials: J
authors.lastname: Miller
authors.forename: Charles S
authors.initials: CS
authors.lastname: Needham
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery; D006801:Humans; D007825:Laryngectomy; D008297:Male; D008323:Mammary Arteries / Q000601:surgery; D012307:Risk Factors; D013249:Sternum / Q000098:blood supply / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D013908:Thoracotomy / Q000379:methods*; D014139:Tracheostomy