Mersilene Ribbon Closure of the Median Sternotomy: An Improvement Over Wire Closure

Johnston, Robert H.; García‐Rinaldi, Raúl; Vaughan, G D; Bricker, Donald L.

doi:10.1016/s0003-4975(10)62530-1

Cited by 23 publications

(6 citation statements)

References 2 publications

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“…Some techniques have been designed to avoid wire cutting through bone the sternal bone either by adding coils [10] or a parasternal vertically oriented basket weave wiring technique [11]. Stainless steel bands [12,13] and Mersilene ribbon [14] have also been utilized in attempts to distribute the closure force over a wider area. Sternal plates in sternal closure [15] have shown better distribution of the force across the sternum that yielding a more secure closure.…”

Section: Discussionmentioning

confidence: 99%

Sternal plating for primary and secondary sternal closure; can it improve sternal stability?

Fawzy

Alhodaib

Mazer

et al. 2009

J Cardiothorac Surg

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BackgroundSternal instability with mediastinitis is a very serious complication after median sternotomy. Biomechanical studies have suggested superiority of rigid plate fixation over wire cerclage for sternal fixation. This study tests the hypothesis that sternal closure stability can be improved by adding plate fixation in a human cadaver model.MethodsMidline sternotomy was performed in 18 human cadavers. Four sternal closure techniques were tested: (1) approximation with six interrupted steel wires; (2) approximation with six interrupted cables; (3) closure 1 (wires) or 2 (cables) reinforced with a transverse sternal plate at the sixth rib; (4) Closure using 4 sternal plates alone. Intrathoracic pressure was increased in all techniques while sternal separation was measured by three pairs of sonomicrometry crystals fixed at the upper, middle and lower parts of the sternum until 2.0 mm separation was detected. Differences in displacement pressures were analyzed using repeated measures ANOVA and Regression Coefficients.ResultsIntrathoracic pressure required to cause 2.0 mm separation increased significantly from 183.3 ± 123.9 to 301.4 ± 204.5 in wires/cables alone vs. wires/cables plus one plate respectively, and to 355.0 ± 210.4 in the 4 plates group (p < 0.05). Regression Coefficients (95% CI) were 120 (47–194) and 142 (66–219) respectively for the plate groups.ConclusionTransverse sternal plating with 1 or 4 plates significantly improves sternal stability closure in human cadaver model. Adding a single sternal plate to primary closure improves the strength of sternal closure with traditional wiring potentially reducing the risk of sternal dehiscence and could be considered in high risk patients.

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Section: Discussionmentioning

confidence: 99%

Sternal plating for primary and secondary sternal closure; can it improve sternal stability?

Fawzy

Alhodaib

Mazer

et al. 2009

J Cardiothorac Surg

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“…Mechanical reinforcement of these closures may be achieved by simply uniting the pectoralis muscles over the sternum as described by Robicsek and Hamilton, 14 such that contraction of these muscles serves to hold the sternal halves together rather than pull them apart. Others have used wider materials such as nylon bands, 15 Mersilene ribbon 16 (Ethicon, Inc, Somerville, NJ), and steel bands 17 to accomplish wider force distribution. Nylon bands have subsequently been associated with a higher rate of sternal wound infection and are not recommended.…”

Section: Table I Average Motion Of Sonomicrometry Crystal Pairs (Cp) In Response To Peak Traction Forces (F Max ) Applied Across the Stermentioning

confidence: 99%

Mechanical analysis of midline sternotomy wound closure

McGregor

Trumble

Magovern

1999

The Journal of Thoracic and Cardiovascular Surgery

145

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“…Wider configurations of various suture materials have also been tried, based on the hypothesis that a larger suture surface area would allow more favorable distribution of distracting forces and better stabilization compared to wires. Polyethylene terephthalate ribbon, jacketed steel wires, and steel bands have been tried but have not been widely adopted, possibly because of the complexity of application [ 16 , 19 , 28 , 29 ]. Nylon bands are associated with an increased incidence of DSWI [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…DSWI is associated with multiple risk factors, including obesity, pulmonary disease, diabetes mellitus, renal failure, advanced age, malnutrition, osteoporosis, and bilateral internal thoracic arterial harvest [ 3 , 6 , 9 – 15 ]. Postoperative complications, such as the low cardiac output syndrome, respiratory failure, and re-exploration for postoperative hemorrhage, have also been shown to contribute to higher incidence of DSWI [ 16 – 19 ]. Effective strategies for reducing the risk of DSWI include appropriately timed and dosed administration of intravenous antibiotic medications, optimal aseptic/antiseptic skin preparation, avoidance of shaving, and intranasal administration of mupricion [ 10 , 20 – 22 ].…”

Section: Introductionmentioning

confidence: 99%

Reduction in deep sternal wound infection with use of a peristernal cable-tie closure system: a retrospective case series

Stelly

Rodning

Stelly

2015

J Cardiothorac Surg

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BackgroundDeep sternal wound infections are a rare but serious complication after median sternotomy. We evaluated the incidence of deep sternal wound infection associated with two techniques for sternal closure.MethodsIn this retrospective case series, we recorded the method of sternal closure in consecutive patients undergoing a variety of cardiothoracic surgical procedures. Sternal closure in the historical control group was performed using trans-sternal, stainless-steel wire sutures; subsequent patients were closed using wire sutures in conjunction with a novel, peristernal cable-tie closure system to reinforce the corpus sterni. Perioperative care was standardized between groups. Demographics, risk factors, and postoperative outcomes were analyzed.ResultsBetween July 2010 and July 2014, 609 consecutive adult patients underwent sternal closure following open median sternotomy at a single hospital in Mobile, Alabama. Sternal closure was accomplished with wire sutures in the first 309 patients and with cable-tie reinforcement in the subsequent 300 patients. Baseline characteristics were comparable between groups, except that the cable-tie group exhibited greater preoperative comorbidity. Mean body mass index was comparable between groups (30.2 ± 6.6 kg/m2 wire suture versus 30.5 ± 7.7 cable-tie, p = 0.568). Deep sternal wound infection occurred in 2.6 % (8/309) patients in the wire-suture group, whereas no deep sternal wound infections were observed in the cable tie group (p = 0.008).ConclusionsThe peristernal cable-tie system was a simple and reliable method for sternal closure after open median sternotomy, and was associated with a reduced risk of deep sternal wound infection, even in an obese and comorbid population.

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Mersilene Ribbon Closure of the Median Sternotomy: An Improvement Over Wire Closure

Cited by 23 publications

References 2 publications

Sternal plating for primary and secondary sternal closure; can it improve sternal stability?

Sternal plating for primary and secondary sternal closure; can it improve sternal stability?

Mechanical analysis of midline sternotomy wound closure

Reduction in deep sternal wound infection with use of a peristernal cable-tie closure system: a retrospective case series

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