The patient was transported to the operating room for repair of the right subclavian injury. A median sternotomy approach was chosen to ensure adequate proximal control. Following induction of anesthesia, the patient was placed supine with the arms drawn inward.
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A vertical incision was made over the sternum from the suprasternal notch to a point 5 cm below the xyphoid. A plane was developed behind the sternum using blunt finger dissection beneath the xyphoid below and beneath the suprasternal notch above (see coronary artery bypass grafts).
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