Approach

• Expose as to examine the chest

1. Inspect
   • Median sternotomy scar runs from suprasternal notch vertically in the midline to the xiphisternum
   • Subtotal median sternotomy involves an incision from the sternomanubrial junction to the 5-6th intercostal space
2. Palpate
   • Occassionally there is non-union of the two sides of themanuibrium sternum thena "click" can be felt on palpation
   • Unless there is co-morbidity, rest of thoracic examination should be normal
3. Percuss
4. Auscultate

Indications for median sternotomy

1. Emergency
   • Following penetrating chest trauma
   • Cardiac surgery
   • Resection of lung cancer
2. Elective