Inclusion Criteria:  Above 18 years of age; Belonging to the transplant queue of InCor; Eligible for sequential bilateral lung transplantation submitted to clamshell incision;  Exclusion Criteria:  Patients undergoing a new surgical procedure after lung transplantation with the need to manipulate the steel wires or the sternal fixation plate other than for osteomyelitis; Intraoperative death; Patients who have undergone unilateral lung transplantation or have not undergone a clamshell incision.