Absorbable sternal pins improve sternal closure stability within a small deviation

Koshiyama, Hiroshi; Yamazaki, Kenji

doi:10.1007/s11748-015-0533-z

Cited by 9 publications

(7 citation statements)

References 17 publications

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“…Previously, we demonstrated that PLLA sternal pins could increase sternal stability particularly under shear stress on the sternum in biomechanical experiments using an extirpated sternum from juvenile swine (9). Koshiyama et al also biomechanically showed the efficacy of hydroxyapatite/ PLLA using an artificial sternum (21). Nevertheless, we could not identify the efficacy of the sternal pins in this study.…”

Section: Discussionmentioning

confidence: 59%

Clinical assessment of efficacy of poly-L-lactide sternal pin on sternal stability and post-operative pain: a prospective randomized trial in cardiovascular surgery

Takahara¹,

Sasaki²,

Saito³

et al. 2022

J Thorac Dis

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Background: Although the incident rate is low, sternal dislocation and dehiscence due to unstable sternal fixation after cardiovascular surgery could cause potentially lethal complications. Thus, to enforce the stability of closed sternum, the sternal pins have been utilized at surgeon's discretion. However, there is no randomized clinical trial to test whether these pins are effective to stabilize a sternum. Hence, this study aimed to examine the clinical efficacy of bioabsorbable poly-L-lactide (PLLA) sternal pins in reinforcing sternal stability and preventing instability of the sternum after full sternotomy. Methods: We conducted a single institutional, prospective, randomized, single-blinded clinical study involving 100 patients who underwent an initial cardiovascular surgery via sternotomy. Patients were randomly allocated into two groups: with (group P) and without (group N) PLLA sternal pins, at 1:1 ratio from November 2013 to April 2016. Sternal deviation and stability were assessed with postoperative computed tomography (CT) at two postures to put shear stress on the sternum. Additionally, information on patient demographic indices was obtained prospectively, and patient's pain intensity was assessed with numerical rating scoring system during rehabilitation. Furthermore, propensity score matching was performed for further comparative sub-analysis.Results: Ninety-one patients (43 in group P and 48 in group N) were analyzed using the intention-to-treat method. Group N had a significantly higher proportion of males (P=0.015) and ischemic disease as a primary diagnosis (P=0.040) than group P. Postoperative CT showed that the degree of sternal deviation and stability were comparable between the groups. Similarly, the numerical rating score of pain during rehabilitation showed no difference between the groups. Even after adjusting for patient characteristics using propensity score matching method, no significant differences in sternal gaps, stability, and numerical rating score of pain were observed. Of note, no material-related adverse event such as wound infection was found. Conclusions: We could not identify the efficacy of the sternal pin in enforcing sternal stability based on CT measurements with mild shear stress on sternum after cardiovascular surgery. Nevertheless, our results with no adverse events might encourage further investigations with a more specific cohort who is susceptible to infection but requires an additional sternal fixation.

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Section: Discussionmentioning

confidence: 59%

Clinical assessment of efficacy of poly-L-lactide sternal pin on sternal stability and post-operative pain: a prospective randomized trial in cardiovascular surgery

Takahara¹,

Sasaki²,

Saito³

et al. 2022

J Thorac Dis

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“…In this cohort, although the use of wire could provide good transverse reduction of the sternum after median sternotomy, it did not provide sufcient longitudinal reduction to reinforce sternal stability. Te sternal pins could nicely complement the longitudinal stability of the wire fxation [21]. Tis study also confrmed that using sternal pins for sternal fxation was positive, efective, and worth promoting, especially in infants with high-risk factors for postoperative thoracic deformities.…”

Section: Discussionmentioning

confidence: 81%

Analysis of Factors Influencing Thoracic Deformities after Median Sternotomy in Infants Who Underwent Congenital Cardiac Surgery

Liu

Lin

Chen

et al. 2023

Journal of Cardiac Surgery

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Objective. To investigate the incidence of thoracic deformities after median sternotomy in infants who underwent congenital cardiac surgery and determine its influencing factors. Methods. This was a single-center retrospective study. A total of 156 infants who underwent congenital cardiac surgery with median sternotomy in a provincial hospital in China from September 2020 to January 2022 were included. Depending on whether thoracic deformities occurred, the patients were classified into the thoracic deformity group and the no thoracic deformity group. Relevant data were retrieved through an electronic medical record system, and statistical comparisons and analyses were performed. Results. The incidence of postoperative thoracic deformities in this cohort was 10.9%. Sternal pins for auxiliary sternal fixation were used in eighty-nine infants. After analysis, it was found that age at operation (1.9 ± 0.9 vs. 3.7 ± 1.2, P < 0.001 ) and weight-for-age Z-scores (−2.0 ± 0.7 vs. −1.4 ± 0.7, P = 0.001 ) of the thoracic deformity group were significantly lower than those of the no thoracic deformity group. In addition, sternal pin use was significantly higher in the no thoracic deformity group than in the thoracic deformity group (61.9% vs. 17.6%, P = 0.001 ). Univariable analysis showed that age at operation (OR, 4.74; 95% CI, 2.38–9.46; P < 0.001 ) and weight-for-age Z-scores (OR, 4.40; 95% CI, 1.74–11.12; P = 0.002 ) were significant risk factors for postoperative thoracic deformity. Using sternal pins for auxiliary sternal fixation was an important protective factor (OR, 7.57; 95% CI, 2.08–27.59; P = 0.003 ). Conclusions. In this study, 10.9% of infants undergoing congenital cardiac surgery through a median sternotomy developed thoracic deformities after surgery. Younger age at operation and poor nutritional conditions may be risk factors for postoperative thoracic deformity. Sternal pin-assisted fixation has a positive effect on the prevention of thoracic deformities.

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“…The cut ends are tightened until the two edges contact, and the wire stumps are buried entirely into the presternal tissue. Internal sternal fixation with absorbable sternal pins can provide additional stability with the possibility of easy re-entry [ 55 ]. Alternatively, sternal wires can be placed in a simple interrupted manner, spaced 1 to 2 cm apart.…”

Section: Closurementioning

confidence: 99%

Penetrating cardiac trauma

Lee¹,

Hameed²,

Kaminsky³

et al. 2023

Surgery Open Science

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Absorbable sternal pins improve sternal closure stability within a small deviation

Abstract: Additional internal fixation using an HA/PLLA sternal pin significantly improved the stability of sternotomy closure in the anterior-posterior and cranial-caudal directions within a small deviation.

Cited by 9 publications

References 17 publications

Clinical assessment of efficacy of poly-L-lactide sternal pin on sternal stability and post-operative pain: a prospective randomized trial in cardiovascular surgery

Clinical assessment of efficacy of poly-L-lactide sternal pin on sternal stability and post-operative pain: a prospective randomized trial in cardiovascular surgery

Analysis of Factors Influencing Thoracic Deformities after Median Sternotomy in Infants Who Underwent Congenital Cardiac Surgery

Penetrating cardiac trauma

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