Closure of the sternotomy incision was limited to the skin in four critically ill patients following cardiopulmonary bypass. One patient had sustained an intractable bleeding diathesis and the other three had ventricular distention which prevented approximation of the sternum. All patients survived after delayed closure and repair of the sternotomy. Delayed primary closure of the sternum is a useful maneuver after cardiac surgery when routine closure would jeopardize early recovery.
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