In case of tight adhesions to the sternum, these adhesions are dissected sharply with scissors.
Between the corpus and manubrium sterni the substernal fascia is very tightly connected to the sternum. Furthermore, the visceral and parietal pleura are tightly connected in this region. For this reason, very careful, stepwise preparation with a long atraumatic clamp has to be performed, and the preparation should be manually controlled by the substernally introduced finger of the surgeon.
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