Mechanical comparison of monofilament nylon leader and orthopaedic wire for median sternotomy closure

McCready, D J; Bell, John; Ness, Malcolm G.; Tarlton, John F

doi:10.1111/jsap.12378

Cited by 10 publications

(36 citation statements)

References 24 publications

(64 reference statements)

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“…The softer material has been shown to have comparable mechanical strength to orthopaedic wire when used for closure of a median sternotomy and should reduce the soft tissue trauma associated with wire placement. 14,15 There were no reported complications with healing of the rib osteotomy, with follow-up ranging from 2 to 40 weeks. There was no palpable change in contour over the osteotomy site, or palpable callus formation, indicative of stability of the osteotomy.…”

Section: Discussionmentioning

confidence: 92%

“…The authors advocate the use of suture material (PDS) rather than orthopaedic wire for closure of the osteotomy. The softer material has been shown to have comparable mechanical strength to orthopaedic wire when used for closure of a median sternotomy and should reduce the soft tissue trauma associated with wire placement . There were no reported complications with healing of the rib osteotomy, with follow‐up ranging from 2 to 40 weeks.…”

Section: Discussionmentioning

confidence: 98%

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Modified rib pivot lateral thoracotomy: a case series

Appelgrein

Hosgood

2018

Aust Veterinary J

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Objective To describe a modified rib pivot thoracotomy and its clinical application in client-owned dogs and cats.Study design Case series of 24 dogs and 1 cat requiring a thoracotomy.Methods A lateral thoracic incision over the required thoracic segment was made. The latissimus dorsi muscle was reflected dorsally. The predetermined rib was identified and the periosteum overlying the rib was elevated circumferentially, avoiding the intercostal neurovascular structures. Holes were pre-placed above and below the proposed osteotomy site. The rib was osteotomised and pivoted cranially. The pleura was incised and the required intrathoracic procedure was then performed. The thoracic cavity was closed by pre-placement of a suture through the pre-placed holes within the osteotomised rib. The pleura and intercostal musculature were closed, avoiding the intercostal neurovascular structures. The rib was re-apposed and the lateral approach was closed. The cases included were reviewed for both the rib pivoted as per the procedure required and postoperative complications. ResultsThe study group comprised 8 Staffordshire Bull Terriers, 2 Poodles, 2 German Shepherd Dogs, 1 each of Basset Hound, Rhodesian Ridgeback, Golden Retriever, Australian Shepherd, Vizsla, Bull Mastiff, Schnauzer, Jack Russell Terrier, Bulldog, Deerhound, Labrador Retriever and Australian Terrier, and 1 cat. A modified rib pivot thoracotomy was performed for lung lobectomy (n = 11), oesophagectomy (7), subtotal pericardectomy (5), patent ductus arteriosus ligation (1) and thoracic duct ligation (1). Follow-up ranged from 2 to 40 weeks postoperatively. Postoperative complications included seroma formation in two dogs.Conclusion A modified rib pivot thoracotomy should be considered as an alternative lateral thoracic approach with good exposure, minimal complications and low morbidity. T he rib pivot lateral thoracotomy was first described in 1988, 1 but has since been neglected as a lateral thoracic surgical approach. Descriptions in textbooks make mention of the rib pivot but imply that the procedure is associated with increased morbidity over a lateral intercostal thoracotomy.2,3 The procedure is usually discussed in connection with rib resection thoracotomy, implying similar morbidity. 4 Although the rib pivot thoracotomy and rib resection thoracotomy afford increased exposure over an intercostal thoracotomy, pivoting the rib affords preservation of the rib and chest wall conformation, and is thus quite different to rib resection. The original proposed benefit to the rib pivot thoracotomy over a rib resection was preservation of the rib and the associated soft tissue structures, thereby minimising the tension placed on the tissues to maintain the integrity of the closure. 1 We describe a modified rib pivot thoracotomy, combined with latissimus dorsi muscle elevation, and its application in a series of cases. Materials and methodsMedical records of dogs that underwent a rib pivot thoracotomy between July 2009 and July 2016 at Murdoch University Veterinary ...

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 98%

Modified rib pivot lateral thoracotomy: a case series

Appelgrein

Hosgood

2018

Aust Veterinary J

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“…The primary objective of median sternotomy closure is to achieve a stable fixation to allow uncomplicated sternotomy healing while minimizing postoperative pain 1,5,18 . In human medicine and veterinary surgery, this is most commonly performed with SSW 1,7‐10,19,20 . The use of alternative materials such as monofilament or multifilament suture, ribbon, tape suture, and cable tie has been described 2,4,7,10,20 .…”

Section: Discussionmentioning

confidence: 99%

“…The peristernal figure eight centered around the sternal synchondrosis has been found to distribute forces over a larger surface area, with less displacement during loading and less malalignment during tensioning compared with other configurations 1 . In a recent biomechanical cadaveric study in dogs, 80‐lb crimped monofilament nylon leader (MNL) used for sternal closure was biomechanically comparable to 20‐gauge SSW, providing a potential alternative for median sternotomy closure in dogs 10 . Monofilament nylon leader is a widely used material for the lateral fabellotibial suture technique in dogs; it is a low cost, nonabsorbable material with a high tensile strength, good handling properties, and a low risk of infection 11‐13 …”

Section: Introductionmentioning

confidence: 99%

Crimped monofilament nylon leader for median sternotomy closure in 10 dogs

Rossanese

Tomlinson

2020

Veterinary Surgery

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Objective: To describe and report the outcomes after closure of median sternotomies with crimped monofilament nylon leader (MNL) in dogs. Study design: Retrospective observational study. Animals: Dogs (n = 10) that underwent intrathoracic surgery through a median sternotomy approach. Methods: The median sternotomy was closed in a peristernal figure eight pattern with crimped MNL. Medical records were reviewed for clinical and histopathological findings and complications. Owners or veterinarians were contacted to collect long-term follow-up information. Results: The technique was simple, with no intraoperative complications. Postoperative infection was documented in one dog, requiring removal of a single MNL and associated crimp clamp. Delayed healing of the surgical incision in one dog was managed conservatively. No other complications were documented throughout long-term follow-up at a median of 488 days (range, 199-608). Conclusion: Median sternotomies were successfully closed with crimped MNL and were associated with a low complication rate. Clinical significance: Crimped MNL represents an alternative method to close median sternotomies in dogs.

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“…It also appears from our search that there are no available studies that correlate the apparent weakness of sternotomy suture closure in large dogs with clinical outcome. Two experimental ex-vivo studies compare the mechanical properties of suture versus wire closure of median sternotomy (Gines et al, 2011& McCready et al, 2015. Both found sutures and wires to be mechanically comparable when exposed to forces deemed as physiological (<400N).…”

Section: Appraisal Application and Reflectionmentioning

confidence: 99%

Which Sternotomy Closure Method (Orthopaedic Wire or Suture) Is Recommended in Large Breed Dogs Undergoing a Median Sternotomy?

Howes

2018

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PICO question Which sternotomy closure method (orthopaedic wire or suture) is recommended in large breed dogs undergoing a median sternotomy?Clinical bottom line The literature search revealed no clinical studies on large breed dogs comparing the clinical outcomes following either orthopaedic wire or suture sternotomy closure methods. Post-mortem studies on large breed dogs suggest that sutures are as suitable as orthopaedic wires for sternal closure with regards to their biomechanical properties. There is insufficient clinical evidence to make a recommendation that sutures be used in large breeds of dog. <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" />

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Mechanical comparison of monofilament nylon leader and orthopaedic wire for median sternotomy closure

Abstract: Monofilament nylon leader is mechanically comparable to stainless steel wire and potentially a suitable alternative for closure of median sternotomy in the dog.

Cited by 10 publications

References 24 publications

Modified rib pivot lateral thoracotomy: a case series

Modified rib pivot lateral thoracotomy: a case series

Crimped monofilament nylon leader for median sternotomy closure in 10 dogs

Which Sternotomy Closure Method (Orthopaedic Wire or Suture) Is Recommended in Large Breed Dogs Undergoing a Median Sternotomy?

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