THE MEDIAN sternotomy incision provides ready access to the anterior and middle mediastinal structures. It especially facilitates a diverse assortment of procedures including: aortic valve replacement, correction of tetralogy of Fallot, ventricular aneurysmectomy, pulmonary embolectomy, innominate endarterectomy, and bilateral internal mammary implantation. One advantage of this avenue of access is that the lungs may be completely aerated during the operative procedure. Atrioventricular shunts are avoided in patients who usually cannot tolerate decrement in the arterial oxygen saturation. The closure of this incision, however, is less than satisfying. Wire is difficult to use. Although the soft bone may be pierced with a cutting needle, it is sometimes necessary to drill holes. The wire may later erode through the skin, which lies close to the sternum, and can cause a chronic draining sinus or osteomyelitis of the sternum. Anchorage in the cancellous bone is insecure and separation of the sternum may occur