title: Precautions related to midline sternotomy in cardiac surgery: a review of mechanical stress factors leading to sternal complications.
abstract: BACKGROUND
  After midline sternotomy patients are instructed on activity precautions to avoid sternal wound complications. We questioned how restrictive these precautions must be, since they can lead to a postoperative decrease in quality of life.
  
  
  OBJECTIVE
  To identify mechanical stress factors causing sternal instability and infection in order to create evidence based guidelines for activity following sternotomy.
  
  
  METHODS
  Literature review.
  
  
  RESULTS
  No evidence was found to support weight limitation regarding activity, as long as the upper arms are kept close to the body and activity is within a pain-free range.
  
  
  CONCLUSIONS
  Avoid stretching both arms backwards at the same time (10 days); loaded activities should be done with the elbows close to the body (eight weeks); only move arms within a pain-free range; use leg rolling with counterweighing when getting in and out of bed; when coughing cross the arms in a "self-hugging" posture; supportive bra or vest is recommended when breast cup>or=D, body mass index>or=35 or frequent cough.
  
  
  CONCLUSIONS
  This study provides insights into mechanical stress factors acting upon sternum and the overlying skin. RECOMMENDATIONS on activity precautions based on these finding have a patient supportive approach focusing on possibilities and not restrictions.
authors.affiliation: Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Hobrovej, postboks 365, DK-9100 Aalborg, Denmark.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Brocki
authors.forename: Charlotte B
authors.initials: CB
authors.lastname: Thorup
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Andreasen
mesh_terms: D006348:Cardiac Surgical Procedures / Q000451:nursing*; D006801:Humans; D013527:Perioperative Nursing / Q000379:methods*; D011183:Postoperative Complications / Q000451:nursing* / Q000517:prevention & control; D056346:Sternotomy / Q000009:adverse effects / Q000451:nursing*; D013249:Sternum / Q000502:physiology; D013314:Stress, Mechanical