Does removal of steel wires relieve post-sternotomy pain after cardiac surgery?

Rashidi, Sargul; Elenbaas, Ted W.O.; Hamad, Mohamed A. Soliman; Suijlekom, Hans J van; Straten, Albert H. van

doi:10.1177/0218492312454278

Cited by 17 publications

(15 citation statements)

References 15 publications

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“…Their removal after healing has been associated with a significant improvement in reported chest pain; however, other causes of persistent chest pain must be excluded. [133][134][135][136][137][138][139] Psychological Interventions…”

Section: Wire Removalmentioning

confidence: 99%

Chronic Poststernotomy Pain

Kleiman

Sanders

Nemergut

et al. 2017

Regional Anesthesia and Pain Medicine

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Chronic pain following median sternotomy is common after cardiac surgery. If left untreated, chronic sternal pain can reduce quality of life, affecting sleep, mood, activity level, and overall satisfaction. This has a significant societal effect given the large number of cardiac surgeries annually. Although a number of pathophysiologic processes and risk factors are assumed to contribute, the exact cause and major risk factors remain unknown. Moreover, the treatment of chronic poststernotomy pain is often inadequate, relying on opioids and other medications that provide minimal benefit to the patient and have significant adverse effects. Indeed, little is known regarding the prevention of chronic pain development following sternotomy. This review aims to present the current, limited data regarding the incidence, risk factors, treatment, and prevention of chronic poststernotomy pain and to identify areas of future research to improve management of this common complaint following cardiac surgery.

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Section: Wire Removalmentioning

confidence: 99%

Chronic Poststernotomy Pain

Kleiman

Sanders

Nemergut

et al. 2017

Regional Anesthesia and Pain Medicine

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“…Some patients perceive the twisted ends of sternal cerclage as truly painful [76]. Other patients can get the twisted ends with its tip to curve in the direction of body skin, and even penetrate it by mechanical stress or remodelling of the bony skeleton.…”

Section: Limitations Of Current Available Sternal Cerclage Wiresmentioning

confidence: 99%

Cardiovascular Applications of Magnesium Alloys

Schilling¹,

Bauer²,

LaLonde³

et al. 2017

Magnesium Alloys

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Therapy in cardiovascular medicine often relies on implantation of prosthetic materials or application of stents. The diseases of many cardiovascular structures require their complete and immediate repair by utilising prosthetic materials. The ideal cardiovascular prosthesis involves good functional properties, capability of regeneration and does not activate the host's immune system. Ideally, the graft can be applied for a temporary use and degrades after a predefined period according to controlled degradation kinetics. Only biological grafts would provide this spectrum of properties by today's level of knowledge. However, biological prostheses exhibit some relevant drawbacks as well, such as insufficient mechanical stability or restricted availability. Implants or supporting structures of magnesium alloys would bridge this gap and would either provide a substrate for innovative and temporary grafts or would-as supporting structures-transiently add some missing properties to regenerative biological prostheses. This chapter reviews the different fields of cardiovascular therapeutic applications of magnesium alloys. The required properties of magnesium alloys and their preparation, fabrication and testing will be discussed under the specific cardiovascular perspective.

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“…It has been shown to be relieved in 83% of sufferers upon wire removal [13,14]. Other causes of post-sternotomy pain are sternal instability and, of course, cardiac ischemia.…”

Section: Discussionmentioning

confidence: 99%

Prospective, randomized, single blinded pilot study of a new FlatWire based sternal closure system

Boustany

Ghareeb

Lee

2014

J Cardiothorac Surg

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BackgroundUnstable steel wire cerclage following open heart surgery may result in increased pain, sternal cut-through, non-union, or dehiscence. These complications lead to longer hospital stays, increased cost, higher morbidity, and patient dissatisfaction. The Figure 8 FlatWire Sternal Closure System is a new construct which is a simple, intuitive, and inexpensive alternative for primary sternal repair following open heart surgery. Prior bench-top testing of FlatWire has demonstrated superior strength and stiffness compared to traditional steel wire. We present our initial experience in a prospective, randomized, single blinded pilot study utilizing this FDA approved system.MethodsSixty-three patients undergoing elective complete sternotomies at a single institution were randomly assigned to receive either the Figure 8 FlatWire or standard steel wire cerclage. All surgeries were performed by a single board certified cardiothoracic surgeon. Data collected included: Age, BMI, pump time, off pump to surgical stop time, length of hospital stay after surgery, cost from time of surgery to discharge, and pain on a visual analog pain scale on the day of discharge, day 30, and day 60.ResultsThe groups were well matched. Patients receiving the Figure 8 FlatWire (33) had a reduction in length of stay compared to patients receiving steel wire circlage (30), but it was not statistically significant (6.8 vs. 7.8 days respectively, p < 0.093). Additionally those with the FlatWire reported significantly decreased pain at day of discharge (3.07 vs. 4.92 points on pain scale, p < 0.0066), with similar pain scores at 30 and 60 days. Off pump to surgery stop time was increased by 15.9 minutes in patients receiving the FlatWire vs. steel wires (55.7 vs. 71.6 minutes, p = 0.00025). Mean cost from surgery until discharge was $87,820.98 in the FlatWire group vs. $91,930.29 in the steel wire group (p < 0.3082).ConclusionEarly clinical results suggest that Figure 8 FlatWire provides excellent stability, which resulted in significantly diminished postoperative pain at discharge. Although not significant there was a trend toward decreased length of stay, and reduced cost. Further clinical research is warranted to expand upon these initial trends and validate long term outcomes.

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Does removal of steel wires relieve post-sternotomy pain after cardiac surgery?

Abstract: We recommend removal of the steel wires in patients with persistent chest pain after median sternotomy, when sternal instability, mediastinitis, and cardiac causes such as ischemia are excluded.

Cited by 17 publications

References 15 publications

Chronic Poststernotomy Pain

Chronic Poststernotomy Pain

Cardiovascular Applications of Magnesium Alloys

Prospective, randomized, single blinded pilot study of a new FlatWire based sternal closure system

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