We ended up making about a 6 to 7 cm incision from the lower aspect of the sternum inferiorly. The subcutaneous tissue was divided. The calcified scar is identified, and this is circumferentially dissected with the cautery. At this point, we now divided this using the rongeur.

We now proceeded proximally, dissecting the xiphoid off of the surrounding fascia. This was done up to its junction with the sternum, and now divided with the rongeur. Following this, hemostasis was obtained with electrocautery. We now mobilized the fascia on either side and closed this with interrupted 0 Prolene sutures. The skin was closed with a deep layer of 3-0 Vicryl and a running 4-0 Monocryl subcuticular stitch. Dermabond was then applied.