A biomechanical study of median sternotomy closure techniques1

Casha, Aaron; Yang, Lang; Kay, Philip; Saleh, Michael; Cooper, Graham

doi:10.1016/s1010-7940(99)00014-7

Cited by 131 publications

(135 citation statements)

References 12 publications

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“…Casha and colleagues calculated that the force generated during coughing is approximately 150 kg, and they recommended that at least 6 simple interrupted wires should be used for sternal closure [6]. In our study, we used 4 figure-of-eight sutures in all cases.…”

Section: Discussionmentioning

confidence: 94%

Early Repair of Sternal Instability Prevents Mediastinitis

Aykut¹,

Albayrak²,

Kavala³

et al. 2014

WJCS

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Background: Discharge due to superficial wound infection and sternal dehiscence are the common complications of median sternotomy. This condition leads to mediastinitis. Mediastinitis is a serious condition which increases morbidity, mortality and hospital costs. The correct time for surgical treatment is contraversial in cases who have sternal dehiscence and discharge due to superficial infection. In this study, patients received sternal stabilization as soon as a diagnosis was made and monitored for the development of mediastinitis. Methods: Among the 1440 patients who had undergone elective CABG, a total of 85 patients who developed sternal dehiscence and superficial wound discharge were included in this study. These patients were re-operated on as soon as diagnosed and early sternal stabilization was provided. Results: The ratio of overall dehiscence was 5.9%. Mediastinitis developed in only 2 of the 85 patients. These patients were treated with VAC (Vacuum Assisted Closure) therapy. The ratio of overall mediastinitis was 0.13. Mediastinitis-related mortality was not detected. Conclusion: The ratio of mediastinitis decreases when patients who have discharge due to sternal dehiscence and superficial wound infection are immediately reviewed without waiting for the results of conventional methods such as antibiotic treatment and chest binder support.

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Section: Discussionmentioning

confidence: 94%

Early Repair of Sternal Instability Prevents Mediastinitis

Aykut¹,

Albayrak²,

Kavala³

et al. 2014

WJCS

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“…This may resolve and heal normally, or it may lead to dehiscence because of fracture of the sternal bone or the sternal wires [2]. SD with or without infection can occur in 0.2% to 5% of patients as a result of primary nonunion, poor wound healing, or premature overexertion [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…Previously reported preoperative risk factors for SD are obesity [2][3][4][5][6][7][8], Diabetes mellitus (DM) [9], chronic obstructive pulmoner disease (COPD) [2][3][4][5][6][7][8][9], chronic cough [10], smoking [2,3], New York Heart Association (NYHA) functional class [11] , osteoporosis [1,2], use of acetylcholinesterase (ACE) inhibitors [10],use of ß-adrenergic drugs for respiratory problems [11], immunosuppression [2][3][4][5][6][7][8][9], and previous sternotomy [9] . Operative risk factors are bilateral internal mammary artery (IMA) harvest [9], excessive amounts of blood transfusion [11], off-midline sternotomy [12], and prolonged cardiopulmonary bypass (CPB) time [3].…”

Section: Introductionmentioning

confidence: 99%

Vitalitec International, The Sternal Closure Device: A novel closure technique for sternal dehiscence

Tunçay

Akçalı²,

Özmen³

et al. 2014

J Clin Exp Invest

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Objective: Impaired sternal wound healing remains problematic after median sternotomy and can cause to significant morbidity after cardiac surgical procedures. Although some reconstruction systems exist for sternal closure, their use is limited by expense and practicality, and simple wire closure remains the most common technique to close the sternum. In this study, we aim to discuss the results of 6 cases that underwent surgery for sternal dehiscence(SD). Methods:We reviewed six patients with sternal dehiscence who underwent surgery in our department between April 2013 and May 2014. We have used a novel closure technique in six patients with sternal dehiscence and evaluated early-term results of sternal clips plus rewiring following failed sternal closure. Results:The mean age was 63 (range, 55 to 79 years). All patients were male. We have used a novel closure technique with sternal clips plus rewiring in all patients. We evaluated six patients with non-infectious SD. Sternal reconstruction using rigid fixation with clips improve bone healing and reduce early postoperative pain. All cases were discharged with successful treatment. Conclusions:We believe that this method of sternal closure guarantees better clinical outcomes rather than sternal wire closure. Additionally, SCD(sternal closure device) clips proved to be cost effective in cardiac surgery. J Clin Exp Invest 2014; 5 (4): 534-538Key words: Sternal dehiscence, closure technique, cardiac surgery ÖZET Amaç: Median sternotomi sonrası bozulmuş sternal yara iyileşmesi kardiak cerrahi sonrası önemli morbidite sebebi olabilir. Sternum kapatılması için bazı teknikler mevcut olmasına rağmen pratikte sınırlıdır ve sternumu basit tel tekniği ile kapatma uygulanan en yaygın tekniktir. Bu çalışmada sternal ayrılma nedeniyle cerrahi uygulanan 6 olgunun sonuçlarını tartışmayı hedefliyoruz. Sonuç: Sternumun bu yöntem ile kapatılmasının tel ile kapatılmasına göre daha etkin ve daha iyi klinik sonuçlar verdiğine inanıyoruz, ayrıca kalp cerrahisinde sternal kapama klipslerin kullanılması daha düşük maliyetli olduğu görülmüştür.

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“…Providing greater stability [3,4,6] and promoting primary osseous healing is crucial for preventing these complications [7][8][9][10][11] . More than 40 different techniques have been described for closing median sternotomy [12][13][14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

Küçükdurmaz

Ağır²,

Bezer³

2013

WJO

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AIM:To increase the stability of sternotomy and so decrease the complications because of instability. METHODS:Tests were performed on 20 fresh sheep sterna which were isolated from the sterno-costal joints of the ribs. Median straight and interlocking sternotomies were performed on 10 sterna each, set as groups 1 and 2, respectively. Both sternotomies were performed with an oscillating saw and closed at three points with a No. 5 straight stainless-steel wiring. Fatigue testing was performed in craniocaudal, anterio-posterior (AP) and lateral directions by a computerized materials-testing machine cycling between loads of 0 to 400 N per 5 s (0.2 Hz). The amount of displacement in AP, lateral and craniocaudal directions were measured and also the op- posing bone surface at the osteotomy areas were calculated at the two halves of sternum. BRIEF ARTICLE RESULTS:The mean displacement in cranio-caudal direction was 9.66 ± 3.34 mm for median sternotomy and was 1.26 ± 0.97 mm for interlocking sternotomy, P < 0.001. The mean displacement in AP direction was 9.12 ± 2.74 mm for median sternotomy and was 1.20 ± 0.55 mm for interlocking sternotomy, P < 0.001. The mean displacement in lateral direction was 8.95 ± 3.86 mm for median sternotomy and was 7.24 ± 2.43 mm for interlocking sternotomy, P > 0.001. The mean surface area was 10.40 ± 0.49 cm² for median sternotomy and was 16.8 ± 0.78 cm² for interlocking sternotomy, P < 0.001. The displacement in AP and cranio-caudal directions is less in group 2 and it is statistically significant. Displacement in lateral direction in group 2 is less but it is statistically not significant. Surface area in group 2 is significantly wider than group 1. CONCLUSION:Our test results demonstrated improved primary stability and wider opposing bone surfaces in interlocking sternotomy compared to median sternotomy. This method may provide better healing and less complication rates in clinical setting, further studies are necessary for its clinical implications.

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A biomechanical study of median sternotomy closure techniques1

Cited by 131 publications

References 12 publications

Early Repair of Sternal Instability Prevents Mediastinitis

Early Repair of Sternal Instability Prevents Mediastinitis

Vitalitec International, The Sternal Closure Device: A novel closure technique for sternal dehiscence

Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

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