CPT® Code 21632

Deleted

1. Indications

The radical resection of the sternum with mediastinal lymphadenectomy is indicated for various thoracic conditions, particularly those involving malignancies or significant disease processes that affect the sternum and surrounding lymphatic structures. The following conditions may warrant this surgical intervention:

• Malignant Tumors - The presence of tumors in the sternum or mediastinal lymph nodes that require removal to prevent further spread of cancer.
• Infections - Severe infections that compromise the integrity of the sternum or surrounding tissues, necessitating surgical intervention to remove infected tissue.
• Trauma - Significant trauma to the chest area that results in damage to the sternum, requiring resection for proper healing and stabilization.

2. Procedure

The procedure for radical resection of the sternum with mediastinal lymphadenectomy involves several critical steps, each essential for the successful completion of the surgery:

• Step 1: Anesthesia and Incision - The patient is placed under general anesthesia to ensure they are unconscious and free from pain. A surgical incision is then made over the sternum and upper chest, providing access to the underlying structures.
• Step 2: Dissection of Soft Tissue - The surgeon carefully dissects the soft tissue surrounding the sternum to expose the bone. This step is crucial for identifying the sternum and ensuring that surrounding structures are preserved as much as possible.
• Step 3: Resection of the Sternum - Once the sternum is adequately exposed, specialized surgical saws and instruments are utilized to completely remove the sternum from the body. This step may involve detaching the ribs from the sternum as well.
• Step 4: Debridement - After the sternum is removed, the surgeon may perform debridement on the ribs and surrounding tissues to remove any necrotic or diseased material, ensuring a clean surgical field.
• Step 5: Mediastinal Lymphadenectomy - If indicated, the surgeon will proceed to perform a mediastinal lymphadenectomy, which involves the removal of lymph nodes located in the mediastinum to assess for any malignancy or disease.
• Step 6: Closure of Incisions - The final step involves the careful closure of all incisions made during the procedure, ensuring that the surgical site is properly sealed to promote healing and minimize complications.

3. Post-Procedure

Post-procedure care following a radical resection of the sternum with mediastinal lymphadenectomy is critical for patient recovery. Patients are typically monitored in a recovery area until they are stable. Pain management is an essential component of post-operative care, as patients may experience significant discomfort following the surgery. Additionally, patients may require respiratory therapy to assist with lung function and prevent complications such as pneumonia. Follow-up appointments are necessary to monitor the surgical site for signs of infection and to assess the patient's overall recovery. The length of recovery can vary based on the individual patient's health status and the extent of the surgery performed.