After open heart surgery, the breastbone (sternum) is divided in order for the surgeon to access the heart. Wires, cords and plates are used to keep the sternum in place. It requires 8-12 weeks to fully recover and heal the supported sternum. Established procedures are a priority to limit the risks of sternal wound complications such as sternal infection, instability or wound dehiscence.
The Cough-Lok aids recovery and increases comfort. This is done by compressing the sternum bone enough to minimise movement and pain whilst allowing for easier breathing, coughing and sneezing. The external support can also be slept in for 24/7 assistance. The Hawksley Cough-Lok is hard wearing, perfect for durability but also useful as studies have shown that non-elastic devices helped minimise sternal complication more in comparison to elastic bandages.
As post-operation precautions, you may be given a ‘traditional sternal precautions list’ with activities and actions to avoid. This strict list might advise to not push or pull using your arms, potentially requiring assistance to dress, wash, get up from chairs, beds and toilets and many domestic tasks whilst you recover.
To progressively regain mobility and prevent kinesiophobia (fear of movement), there have been modified sternal precautions introduced in recent years. This promotes unloaded arm movements within a range that is pain free as well as loaded arm movements as long as the upper arm stays in close proximity to their body. Adams et al. describe it as “Keep Your Move in the Tube” as long as you move within a small cylinder (“tube’) around your torso summarised in the video below.
Frequently Asked Questions
How will I dress myself?
Pick loose clothing that is easy to put on and off
Dress whilst sitting
Make sure your arms are always close to your sides
Do not pull on your incision
For shirts, fit your arms into the sleeves up to the elbows. After this, you gently alleviate your arms up, keeping them close in to let the shirt fall and allow for you to duck your head in.
For trousers, place your feet into the trouser legs, then raise the trousers once you stand up.
Why is a pillow given?
Pillows should be hugged when sneezing or coughing to alleviate pressure from the chest and lungs.
To make sure the chest is properly stabilised, studies recommend having a rigid device such as a Cough-Lok to keep the sternum from moving.
Can sternal wires be removed?
As the sternal wires hold the chest in place, they are not often removed.
Removal might take place in special cases where an individual experiences persistent pain or allergic reactions related to the sternal wires.
Symptoms are shown to resolve in most of these patients and is a generally uncomplicated procedure.
What should I do for the first 3 months?
Avoid strenuous activities i.e., weightlifting, jogging, vacuuming, etc.
Attempt to walk at least once a day. Walking will help increase blood flow to aid recovery and prevent constipation and pneumonia.
Resting sufficiently helps to recover properly.