Abstract:
The present disclosure relates to methods and devices for stanching the effusion of blood from the exposed ends of the sternal halves of an incised sternum during cardiac and/or thoracic surgical procedures. According to an aspect, there is provided a device for stanching the effusion of blood from an exposed sternal half of a sternum formed during a sternotomy. The device includes an end wall having a size and a dimension to at least partially cover the exposed end of a sternal half. The device may include an upper wall; a lower wall spaced from the upper wall; and an end wall interconnecting the upper and lower walls. The upper wall, the lower wall and end wall bound a space while the upper wall and the lower wall define an opening through which an exposed end of a sternal half is receivable into the space of the device.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS  
       [0001]    The present application claims the benefit of and priority to U.S. Provisional Application Serial No. 60/456,303, filed on Mar. 20, 2003, the entire content of which is incorporated herein by reference. 
     
    
     
       BACKGROUND  
         [0002]    1. Technical Field  
           [0003]    The present disclosure relates generally to methods and devices associated with cardiac and/or thoracic surgery and, more particularly, to methods and devices for minimizing the loss of blood through a severed sternum during cardiac and/or thoracic surgical procedures.  
           [0004]    2. Background of Related Art  
           [0005]    A full median sternotomy is probably the most common procedure performed today for providing surgical access to the heart and coronary arteries. A sternotomy, however, is highly invasive. The patient&#39;s skin is incised at the midline overlying the chest and the patient&#39;s sternum is cut, using a saw or other comparable cutting instrument, along at least a portion, typically, along its entire length. The cut edges of the sternum are then spread with metal retractors, exposing a large cavity to allow surgery to be performed on the heart. Generally, such retractors use two substantially perpendicular retractor blades that remain generally at the same height in their operative position.  
           [0006]    The retractor blades are then manipulated (e.g., spread apart) an amount sufficient to create an opening in the thoracic cavity which is large enough through which a surgeon may directly visualize and operate upon the heart and the other thoracic organs or tissue. Following such a procedure, the two severed sternal halves must be reapproximated, i.e., the sternum is rejoined and closed securely using known surgical techniques and devices.  
           [0007]    The sternotomy typically results in the effusion or loss of blood, at times severe and at other times quite excessive, during the surgical procedure. This loss of blood may obstruct and at times may obliterate the view of the surgical team when performing the surgical procedure.  
           [0008]    Recently, waxes, gels and the like have been developed to be applied to the bleeding surfaces of the sternum halves following the cutting of the sternum. These substances include compositions (e.g., astringents and the like) which help to inhibit and/or otherwise reduce the effusion of blood. It would be beneficial if these substances could be removed from the sternum halves and, more importantly, from the thoracic cavity, following the surgical procedure. However, the current state of the art is lacking in this regard. These substances are left in the sternum (i.e., between the sternal halves) following the surgical procedure, and cause contamination of the blood cells which may lead to additional post operative procedures and treatments. Also, these substances have proven to be less than effective in performing their intended function, i.e., inhibiting the effusion of blood.  
           [0009]    Accordingly, a continuing need exists for improved methods and devices for minimizing the loss of blood through a severed sternum during cardiac and/or thoracic surgical procedures.  
           [0010]    The need exists for devices which may be removably placed over an exposed end of each sternal half prior to use of a conventional retractor.  
         SUMMARY  
         [0011]    The present disclosure relates to methods and devices for stanching the effusion of blood from the exposed ends of the sternal halves of an incised sternum during cardiac and/or thoracic surgical procedures.  
           [0012]    According to one aspect of the present disclosure, there is provided a device for stanching the effusion of blood from an exposed sternal half of a sternum formed during a sternotomy. The device includes an end wall having a size and a dimension to at least partially cover the exposed end of a sternal half, wherein the device stanches the effusion of blood from the exposed end of the sternal half.  
           [0013]    The device further includes an upper wall integrally formed with and extending orthogonally from an upper edge of the end wall; and a lower wall integrally formed with and extending orthogonally from a lower edge of the end wall. The end wall may include a rounded first and second end. The upper wall and the lower wall may extend along the first and second ends of the end wall. The upper wall and the lower wall define a continuous wall around the perimeter of the end wall.  
           [0014]    The device may further include anchoring structure extending from the end wall. The anchoring structure may include at least one spike protruding from a surface of the end wall to contact the exposed end of the sternal half. The spikes may be removably connected to the end wall.  
           [0015]    The device may further include a wall extending around at least a portion of the end wall. The end wall may be fabricated from at least one of plastic, stainless steel and/or titanium.  
           [0016]    According to another aspect of the present disclosure, a device for stanching the effusion of blood from an exposed sternal half of a longitudinally divided sternum, formed during a sternotomy, is provided. The device includes an upper wall; a lower wall spaced from the upper wall; and an end wall interconnecting the upper and lower walls. The upper wall, the lower wall and end wall bound a space. The upper wall and the lower wall define an opening through which an exposed end of a sternal half is receivable into the space of the device.  
           [0017]    The device may have a “C-shaped” or a “U-shaped” transverse cross-sectional profile, wherein the surface contacting the exposed end of the sternal half is substantially flat. The upper wall, the lower wall and the end wall desirably has a radius of curvature of about 8.625 inches. The upper wall has a thickness of about 0.1875 inches. The lower wall has a thickness of about 0.0625 inches. The device may be fabricated from a plastic.  
           [0018]    The device may further include a first and a second terminal end. The terminal ends may be arcuate. Desirably, the space between the upper and lower walls of the device has a height of about 0.75 inches.  
           [0019]    According to another aspect of the present disclosure, a method of minimizing the effusion of blood from the exposed ends of a sternal half of a longitudinally divided sternum, formed during a sternotomy, is provided. The method includes the steps of providing a pair of devices for stanching the effusion of blood from the exposed ends of the sternal halves; and placing a device against each exposed end of each sternal half. The devices are disposed between the exposed end of each sternal half and a blade of a surgical retractor.  
           [0020]    Each device may include an upper wall; a lower wall spaced from the upper. wall; and an end wall interconnecting the upper and lower walls. The upper wall, the lower wall and end wall bound a space. The upper wall and the lower wall define an opening through which the sternal half is receivable into the space of the device. Each device may have a substantially C-shaped transverse cross-section profile, wherein the surface of the device in contact with the exposed end of the sternal half is substantially flat. Each device may be fabricated from plastic, stainless steel and/or titanium.  
           [0021]    The method may further include the step of imaging or estimating the size of the sternum to determine the size of the device required for the surgical procedure. The method may further include the steps of placing the blades of a surgical retractor, when in an approximated position, between the devices placed over the exposed ends of the sternal halves; and manipulating the retractor to separate the blades of the surgical retractor and spread the sternal halves apart.  
           [0022]    In a sternotomy wherein the sternum of a patient has been longitudinally incised along at least a portion thereof, thereby exposing and allowing two opposing sternal halves to be separated laterally, the improvement includes the step of providing a pair of caps for stanching the effusion of blood from the exposed sternal halves of the sternum. Each cap including an upper wall; a lower wall spaced from the upper wall; and an end wall interconnecting the upper and lower walls. The upper wall, the lower wall and end wall bound a space. The upper wall and the lower wall define an opening through which the sternal half is receivable into the space of the cap. The improvement further includes placing a cap on each exposed sternal half such that the sternal half is received in the space of the cap.  
           [0023]    Each cap may be fabricated from plastic, stainless steel and/or titanium.  
           [0024]    The method further includes the steps of placing the blades of a surgical retractor, when in an approximated position, between the caps placed over the exposed ends of the sternal halves; and manipulating the retractor to separate the blades of the surgical retractor and spread the sternal halves apart. Each cap may include at least one spike extending from the end wall thereof.  
           [0025]    The method may further include the steps of providing clips for guiding and securing the caps against the exposed ends of the sternal halves; and placing the clips over the caps and into engagement with the sternal halves.  
           [0026]    Other objects and further scope of the applicability of the present invention will become apparent from the detailed description to follow, taken in conjunction with the accompanying drawings wherein like parts are designated by like reference numerals. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0027]    The foregoing and other aspects of the present invention will best be appreciated with reference to the detailed description of the invention in conjunction with the accompanying drawings, wherein:  
         [0028]    [0028]FIG. 1 is a perspective view of a device, according to an embodiment of the present disclosure, for covering an exposed end of a sternal half of a longitudinally divided sternum;  
         [0029]    [0029]FIG. 2 is a cross-sectional side elevational view of the device of FIG. 1, as taken through  2 - 2  of FIG. 1;  
         [0030]    [0030]FIG. 2A is a cross-sectional side elevational view of the device of FIG. 1, as taken through  2 - 2  of FIG. 1, illustrating another cross-sectional profile for the device of FIG. 1;  
         [0031]    [0031]FIG. 3 is a top plan view of the device of FIGS. 1 and 2;  
         [0032]    [0032]FIG. 4 is a front elevational view of the device of FIGS. 1-3;  
         [0033]    [0033]FIG. 5 is a perspective view of a device for covering an exposed end of a sternal half of a longitudinally divided sternum, according to an alternate embodiment of the present disclosure;  
         [0034]    [0034]FIG. 6 is a cross-sectional side elevational of the device of FIG. 5, as taken through  6 - 6  of FIG. 5;  
         [0035]    [0035]FIG. 7 is a top plan view of the device of FIGS.  5 and  6 ;  
         [0036]    [0036]FIG. 8 is a perspective view of a device for covering an exposed end of a sternal half of a longitudinally divided sternum, according to yet another embodiment of the present disclosure;  
         [0037]    [0037]FIG. 9 is a cross-sectional side elevational view of the device of FIG. 8, as taken through  9 - 9  of FIG. 8, illustrating an embodiment of an anchoring structure extending therefrom;  
         [0038]    [0038]FIG. 10 is a cross-sectional side elevational view of the device of FIG. 8, as taken through  9 - 9  of FIG. 8, illustrating another embodiment of an anchoring structure extending therefrom;  
         [0039]    [0039]FIG. 11 is a cross-sectional side elevational view of the device of FIG. 8, as taken through  9 - 9  of FIG. 8, illustrating yet another embodiment of an anchoring structure extending therefrom;  
         [0040]    [0040]FIG. 12 is a perspective view of a device for covering an exposed end of a sternal half of a longitudinally divided sternum, according to still another embodiment of the present disclosure;  
         [0041]    [0041]FIG. 13 is a perspective view of a device for covering an exposed end of a sternal half of a longitudinally divided sternum, according to yet another embodiment of the present disclosure;  
         [0042]    [0042]FIG. 14 is a perspective view of a device for covering an exposed end of a sternal half of a longitudinally divided sternum, according to still another embodiment of the present disclosure;  
         [0043]    [0043]FIG. 15 is a cross-sectional side elevational view of the device of FIG. 14;  
         [0044]    [0044]FIG. 16 is a top plan view of the device of FIGS. 14 and 15;  
         [0045]    [0045]FIG. 17 is a perspective view of a device for covering an exposed end of a sternal half of a longitudinally divided sternum, according to another embodiment of the present disclosure;  
         [0046]    [0046]FIG. 18 is a schematic illustration of a patient&#39;s rib cage depicting the longitudinal separation of the patient&#39;s sternum;  
         [0047]    [0047]FIG. 19 is cross-sectional view of the patient&#39;s rib cage of FIG. 18, as taken through  19 - 19  of FIG. 18, illustrating the insertion of the device of FIGS. 1-4 between the sternal halves and onto the exposed end surfaces thereof;  
         [0048]    [0048]FIG. 20 is a cross-sectional view of the patient&#39;s rib cage of FIG. 18, as taken through  19 - 19  of FIG. 18, illustrating the insertion of a retractor between the sternal halves and into cooperating engagement with the device of FIGS. 1-4;  
         [0049]    [0049]FIG. 21 is a perspective view illustrating the retraction of the sternal halves of FIG. 20 by the retractor;  
         [0050]    [0050]FIG. 22 is a cross-sectional view of the patient&#39;s rib cage, as taken through  19 - 19  of FIG. 18, illustrating the use of alignment structure to position the device of FIGS. 8-11 against the exposed end of the sternal halves; and  
         [0051]    [0051]FIG. 23 is a cross-sectional view of the patient&#39;s rib cage, as taken through  19 - 19  of FIG. 18, illustrating the use of clips to position the device of FIGS. 8-11 against the exposed end of the sternal halves. 
     
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS  
       [0052]    Devices and methods of using the devices according to the present disclosure are provided to be used with a sternum retractor or the like. While the structure and use of various embodiments of the device of the present disclosure are discussed in detail below, it should be appreciated that the present disclosure provides for inventive concepts capable of being embodied in a variety of specific contexts. The specific embodiments of the devices discussed herein are merely illustrative of their specific construction and of their specific method of using and are not to be interpreted as limiting the scope of the instant disclosure. While the devices and methods will be described with a certain degree of particularity, it will be clear that changes may be made in the details of construction and/or sequence of use without departing from the spirit and scope of this disclosure. It is further understood that the description of the devices set forth below is not to be limited to those embodiments, and that additional embodiments may be appreciated by one of skill in the art.  
         [0053]    Referring initially to FIGS. 1-4, wherein like reference numerals refer to like elements, according to a first embodiment of the present disclosure, a device, cuff or cap, for stanching the effusion of blood from an exposed end of a sternal half, is designated as  100 . Device  100  includes a planar wall  106  surrounded by a perimetral wall defined by an upper wall  102 , a lower wall  104 , a first side end wall  112 , and a second side end wall  114 . The perimetral wall bounds a space  110  and defines an opening  116  to space  110 . Preferably, end walls  112  and  114  are rounded.  
         [0054]    Preferably, as seen in FIG. 4, upper wall  102  has a thickness of about 0.1875 inches and lower wall  104  has a thickness of about 0.0625 inches. While device  100  has been shown and described as including an upper wall  102  and a lower wall  104  having different thicknesses, it is envisioned and within the scope of the present disclosure for upper and lower walls  102  and  104  to have a uniform thickness throughout.  
         [0055]    Device  100  has an overall length “L” (see FIG. 4) which is preferably larger than the length of the exposed end surface of a sternal half of a longitudinally divided sternum. Preferably, device  100  has a length “L” which is from about 5.0 inches to about 8.0 inches, most preferably, about 6.6875 inches. Desirably, device  100  has a length “L” which is greater than the width of a blade of a surgical retractor.  
         [0056]    As best seen in FIG. 2, space  110  of device  100  has a height “H” (prefreably greater than the height of the exposed end of the sternal half) and a depth “D”. Preferably, space  110  has a height “H” of about 0.75 inches and a depth “D” of about 0.0625 inches.  
         [0057]    As seen in FIG. 2, device  100  may include a substantially flat rear surface  106   a , or as seen in FIG. 2A, device  100  may include an arcuate rear surface  106   b . Additionally, as seen in FIGS. 2 and 2A, device  100  preferably includes a front surface  106   c , disposed between upper and lower walls  102 ,  104  and opposite rear surface  106   a  or  106   b . Preferably, front surface  106   c  is at least substantially flat along the entire surface thereof in order to best contact the exposed end surface of sternal halves “S 1 ” and/or “S2”.  
         [0058]    As best seen in FIG. 4, device  100  defines a longitudinal axis “X”. Device  100  and, more particularly, upper and lower walls  102 ,  104  and end wall  106  are curved along at least a portion of the, preferably along the entire, length thereof. Device  100  has a radius of curvature “R” of about 8.625 inches. While it is desirable for device  100  to be curved along at least a portion of the length thereof, it is envisioned and within the scope of the present disclosure for device  100  to be substantially linear along the entire length thereof. Accordingly, as seen in FIG. 4, device  100  has a kidney-like or bean-like foot print.  
         [0059]    Device  100  is preferably fabricated from a polycarbonate material, such as, for example, Lexan. While device  100  is preferably fabricated from a polycarbonate material, it is envisioned and within the scope of the present disclosure that device  100  may be fabricated from other biologically compatible and/or biologically inert materials, such as, for example, polyethylene, polypropylene, other polymeric materials, stainless steel, titanium and the like. Preferably, device  100  is fabricated from a material which may be autoclaved for reuse.  
         [0060]    Turning now to FIGS. 5-7, a device, for stanching the effusion of blood from an exposed end of a sternal half, is designated as  200 . Device  200  is similar to device  100  and will only be described to the extent necessary to identify differences in construction and operation.  
         [0061]    Device  200  includes a planar wall  206  having an outer terminal edge  220 . Device  200  has a substantially kidney-shaped or bean-shaped foot print. As seen in FIGS. 6 and 7, while device  200  is substantially planar in both a longitudinal (X-direction) and a transverse (Y or Z-direction) direction, it is envisioned and within the scope of the present disclosure that device  200  may be curved in the longitudinal and/or transverse directions.  
         [0062]    Turning now to FIGS. 8-11, anchoring structure, for fixing the position of device  100  against the exposed end of the sternal half, are shown and described. As seen in FIGS. 8 and 9, the anchoring structure includes at least one spike  130  extending from the surface of end wall  106 . Preferably, spikes  130  are integrally formed with and/or monolithically formed with end wall  106 .  
         [0063]    As seen in FIG. 10, the anchoring structure may take the form of threaded spikes  130   a  which are threadingly received in apertures  132  formed in end wall  106 .  
         [0064]    As seen in FIG. 11, the anchoring structure may take the form of barbed spikes  130   b  having an inter-engaging proximal end  134 , which is received in an aperture  132  formed in end wall  106 , and an arrowhead-shaped distal end  136 .  
         [0065]    Desirably, the anchoring structure (e.g., spikes  130 ,  130   a  and  130   b ) is secured to and/or otherwise integrally formed with end wall  106  in such a manner that the anchoring structure will not break away or otherwise separate from end wall  106 .  
         [0066]    Turning now to FIG. 12, an alternate embodiment of a device for stanching the effusion of blood from an exposed end of sternal half, is designated as  300 . Device  300  includes an end wall  306  having an upper wall  302  and a lower wall  304 . Upper wall  302 , lower wall  304  and end wall  306  define an open ended channel  310  having a substantially “C-shaped” or “U-shaped” transverse cross-sectional profile, wherein a surface of device  300  in contact with the exposed end of the sternal half is at least substantially flat. Preferably, upper wall  302  and lower wall  304  extend along at least a portion of the length of end wall  306 .  
         [0067]    As seen in FIG. 13, yet another embodiment of a device for stanching the effusion of blood from an exposed end of a sternal half, is designated as  400 . Device  400  includes an end wall  406  having an upper terminal edge  406   a  and a lower terminal edge  406   b . Device  400  includes at least one, preferably a pair of, arms or guides  440   a ,  440   b  extending transversely from each of upper terminal edge  406   a  and lower terminal edge  406   b . Arms  440   a ,  440   b  act to guide device  400  onto and against the exposed end of the sternal half.  
         [0068]    Referring now to FIGS. 14-17, a device for stanching the effusion of blood from an exposed end of a sternal half, according to still another embodiment of the present disclosure, is designated as  500 . As seen in FIGS. 14 and 15, device  500  has a substantially “C-shaped” or “U-shaped” transverse cross-sectional profile. Device  500  includes a pair of juxtaposed walls, namely, an upper wall  502  and a lower wall  504 , interconnected by an end or base wall  506 . Upper and lower walls  502 ,  504  and end wall  506  bound a space  510 . Meanwhile, upper and lower walls  502 ,  504  define an opening  512  therebetween.  
         [0069]    Device  500  further defines a first and second terminal end  512 ,  514 . Preferably, terminal ends  512 ,  514  are curved to thereby provide a smooth transition from upper and lower walls  502 ,  504  to end wall  506 . While first and second terminal ends  512 ,  514  are preferably curved, it is envisioned and within the scope of the present disclosure that first and second terminal ends  512 ,  514  may be flattened, truncated or otherwise defined.  
         [0070]    Desirably, device  500  is fabricated from a material having a degree of flexibility such that upper wall  502  and lower wall  504  may be spread apart from one another to conform to the needs of the particular surgical procedure.  
         [0071]    It is envisioned and within the scope of the present disclosure that the surface of the sternal half capping devices, which is to contact the exposed surface of the sternal half, may be provided with and/or otherwise coated with a medicament “M”. (see FIGS. 2 and 3). Medicament “M” includes and is not limited to antibiotics, astringents and hemostats. It is further envisioned that medicament “M” may take the form of a gel, paste, wax or a wafer. In this manner, when the sternal half capping devices are placed over sternal halves “S 1 ” and “S 2 ”, the effusion of blood may be further retarded.  
         [0072]    With reference to FIGS. 18-22 a method of use of device  100  will be shown and described. As seen in FIG. 18, the sternum “S” of a patient is longitudinally divided using known surgical techniques, such as, for example, using a saw or other appropriate cutting instrument, to make a midline, longitudinal incision “C” along at least a portion of the patient&#39;s sternum “S”, thereby allowing two opposing sternal halves “S 1 , S 2 ” to be separated laterally.  
         [0073]    Turning now to FIG. 19, with sternum “S” divided along incision “C”, a first device  100   a  for capping the exposed end of sternal half “S 1 ” is placed over first sternal half “S 1 ” and a second device  100   b  for capping the exposed end of sternal half “S 2 ” is placed over second sternal half “S 2 ”. In particular, first sternum capping device  100   a  is placed over first sternal half “S 1 ” such that first sternal half “S 1 ” is received in space  110  (see FIG. 2) through opening  112  (see FIG. 2). Likewise, second sternal capping device  100   b  is placed over second sternal half “S 2 ” such that second sternal half “S 2 ” is received in space  110  (see FIG. 2) through opening  112  (see FIG. 2). Each sternal capping device  100   a ,  100   b  acts to stanch the flow of blood effusing from sternal halves “S 1 ”,“S2”.  
         [0074]    Preferably, the cross-sectional profile and dimensions of sternum “S” may be quite accurately ascertained prior to the surgical procedure and/or prior to the incising of sternum “S” by means of various diagnostic procedures, including, and not limited to, X-rays, CT scans, and MRI images. This permits having for instantaneous use, properly sized and shaped sternal capping devices  100   a ,  100   b  that may be positioned over the first and second sternal halves “S 1 ”, “S 2 ” immediately following the incising of sternum “S”.  
         [0075]    Turning now to FIG. 20, following placement of sternal capping devices  100   a ,  100   b  over first and second sternal halves “S 1 ”, “S 2 ”, as described above, a retractor  10  is then used to maintain a thoracic cavity access via the sternal incision “C”. Briefly, retractor  10  includes a rack  20 , a first blade  30  fixedly attached to rack  20 , and a second blade  40  movable along a portion of rack  20 . Retractor  10  further includes attaching means  50  which permits first blade  30  and second blade  40  to move between a closed position and an open position.  
         [0076]    With first and second blades  30  and  40  of retractor  10  in the first position second blade  40  is inserted between first and second sternal halves “S 1 ” and “S 2 ”. Sternal halves “S 1 ” and “S 2 ” are then separated by an amount sufficient to allow passage of first blade  30  between sternal halves “S 1 ” and “S 2 ”. First and second sternal capping devices  100   a ,  100   b  prevent direct contact of blades  30 ,  40  of retractor  10  against the exposed surfaces of sternal halves “S 1 ” and “S 2 ”. As mentioned above, sternal capping devices  100   a ,  100   b  have a length which is larger than the width of blades  30 ,  40  of retractor  10 .  
         [0077]    As seen in FIG. 21, with blades  30 ,  40  of retractor  10  positioned between sternal halves “S 1 ” and “S 2 ”, retractor  10  is operated and/or otherwise manipulated to thereby separate blades  30 ,  40  and, in turn, to laterally separate sternal halves “S 1 ” and “S 2 ” from one another. As so positioned, sternal capping devices  100   a ,  100   b  are in interposed between respective sternal halves “S 1 ” and “S 2 ”, and blades  30 ,  40  of retractor  10 .  
         [0078]    It is envisioned that sternal capping devices  100  may be available in several different sizes so that the surgeon may choose those caps which are large enough to surround the cross-sectioned sternum (i.e., sternal halves “S 1 ” and “S 2 ”) without requiring more space in the chest cavity then absolutely necessary. It is further envisioned that sternal capping devices  100  may be supplied in a pair, e.g., as a left side capping devices and a right side capping devices.  
         [0079]    It is envisioned and within the scope of the present disclosure that sternal capping devices  100  may be specially or custom fabricated to accommodate any deformity or inconsistency in the topographical or cross-sectional profile of sternum “S”.  
         [0080]    As seen in FIG. 17, sternal capping device  500  may be molded or fabricated to include customized mounting pads for holding special tools, optical devices, aspirators and the like. For example, as seen in FIG. 17, sternal capping device  500  may be provided with a hook  530   a  or a pair of resilient fingers  530   b  extending from upper wall  502  thereof. Hook  530   a  or fingers  530   b  act to retain the special tools, optical devices or aspirators in a snap-fit type engagement.  
         [0081]    As seen in FIG. 22, if sternal capping device  100  includes spikes  130 , when sternal capping devices  100  are placed against the exposed ends of sternal halves “S 1 ” and “S 2 ”, spikes  130  are pressed into the marrow of sternal halves “S 1 ” and “S 2 ”. Spikes  130  help to further anchor and/or orientate sternal capping device  100  against the exposed ends of sternal halves “S 1 ” and “S 2 ”.  
         [0082]    In addition to or in lieu of spikes  130 , as seen in FIG. 22, clips  140  may be provided which facilitate orientation and placement of sternal capping devices  100  against the exposed end of sternal halves “S 1 ” and “S 2 ”. Clips  140  include a backspan  142  which engages sternal capping devices  100 , and a pair of legs  144  extending from backspan  142  to overlie the upper and lower surfaces of sternal halves “S 1 ” and “S 2 ”. Preferably, backspan  142  is fixedly secured to sternal capping devices  100   a , 100   b.    
         [0083]    Turning now to FIG. 23, in addition to or in lieu of spikes  130 , spring clips  150  may be provided to fix and/or otherwise anchor sternal capping devices  100   a ,  100   b  against the respective exposed end surface of sternal halves “S 1 ” and “S 2 ”. Preferably, clips  150  are configured such that the legs thereof wrap around sternal capping devices  100   a ,  100   b  and engage and/or contact the exposed sternal half along an upper and lower surface thereof. Preferably, clips  150  are configured such that the backspan thereof contacts and/or presses against the surface of sternal capping devices  100   a ,  100   b . Most preferably, the backspan of each clip  150  is fixedly secured to sternal capping devices  100   a.    
         [0084]    Preferably, clips  140  and  150  are fixedly secured to sternal capping devices  100   a ,  100   b  using known methods and techniques. For example, clips  140 ,  150  may be welded to, integrally formed with, adhered to, screwed to and/or otherwise fixedly secured to sternal capping devices  100   a ,  100   b . Preferably, clips  140 ,  150  are fixedly secured to sternal capping devices  100   a ,  100   b  in such a manner so as to not readily separate from sternal capping devise  100   a ,  100   b  during the surgical procedure.  
         [0085]    While the sternal capping devices have been described in connection with what is presently considered to be the most practical and preferred embodiments, it is to be understood that the sternum capping devices are not to be limited to the disclosed embodiments, but on the contrary, it is intended to cover various modifications and equivalent arrangements included within the spirit and scope of the appended claims.