A new method of sternal approximation

Abstract

After sternotomy for a cardiac operation in adults, closure of the sternum is accomplished with five or six wire sutures with twisting of the wire ends. This method may not achieve rigid fixation of the sternum, and the bulky twisted wires may cause skin pain or actual perforation. We have developed a new method of approximating the split sides of the sternum using a new in-

Multiaxial Miniaturized Load Cell for Measuring Forces Acting Through a Sternotomy

“…Median sternotomy (longitudinal incision into the breastbone) is the most commonly used technique for gaining exposure of the mediastinum (the space between the breastbone and the lungs) during heart and lung surgery. Sternotomy closure is commonly performed by means of transverse stainless steel wires placed around the sternum (breastbone) body and through the manubrium (the superior part of the sternum) 1 . Complications related to median sternotomy occur in 0.5–5% of the patients 2–6 .…”

“…Sternotomy closure is commonly performed by means of transverse stainless steel wires placed around the sternum (breastbone) body and through the manubrium (the superior part of the sternum). 1 Complications related to median sternotomy occur in 0.5-5% of the patients. [2][3][4][5][6] Wire failure, wire cutting through the bone (with consequent loosening of the fixation), bone fracture (associated with the stress concentration caused by the wires), sternal dehiscence (splitting), pseudoarthrosis (inability to form new bone), and wound infection are potential problems.…”

“…Furthermore, the use of absorbable devices introduces the problem of correctly evaluating the bioabsorption process of the material occurring in vivo. To assure the effectiveness of the new material, the device must be sized correctly for two reasons: (1) to assure the required mechanical strength during tissue healing, despite the change in the mechanical behavior of the material due to bioabsorption, and (2) to allow practical handling for the surgeon. Therefore, it is necessary to know the physiological loads acting through the operated sternum.…”

Experimentelle Untersuchungen zur Stabilisierung der Refixation nach medianer Sternotomie

“…mittels Metallclip gespannt wird [5,7,8,9,11,15]. Am h~iufigsten wird monofiler Stahldraht benutzt, der entweder transsternal oder parasternal geffihrt und durch Verdrillung bzw.…”

Nueva técnica de cierre postesternotomía: estudio clínico y experimental

“…directrices fueron: abarcar el esternón en su totalidad, una correcta apertura y evitar el daño que sufren los alambres al retorcerse, aconsejando el cierre en 8 o las bandas.Un punto de inflexión respecto al resto de los trabajos, es que analiza las características de los pacientes, mencionando alguno de los primeros factores de riesgo independientes de dehiscencia basados en un análisis estadístico: la reintervención.Añadir que esporádicamente surgen nuevas ideas para facilitar las técnicas ya descritas157,152 , o tratamientos originales pero ocasionales ante dehiscencias complejas 126,51 .En los años 80 aparecen grandes aportaciones ya que los trabajos se llevan a cabo con un rigor estadístico muy superior, no sólo por el número de enfermos, sino por el análisis pormenorizado de todos ellos. Es de interés el realizado in vitro por Rooks 126 , mejorando algunos de los errores de Timmes, al darle importancia a la torsión del alambre dado que como sabemos lo debilita.…”