Real-time ultrasound assessment of sternal stability in adhesive-enhanced sternal closure

Abstract

Purpose: Conventional sternal closure by wire cerclage is the current standard of care worldwide but can result in pathologic sternal displacement and persistent sternal pain. The aim of this case report was to quantify sternal separation and sternal micro-motion in two patients following conventional wire cerclage alone (patient 1) and adhesive-enhanced closure on a platform of wire cerclage (patient 2) respectively. Description: Sternal separation and micro-motion was measured using real-time ultrasound. Pain and sternal stability were assessed using a Visual Analogue Scale (VAS) and the Sternal Instability Scale (SIS) respectively.Evaluation: Patient 1 demonstrated sternal separation and micro-motion that was evident in the coronal and sagittal planes during upper limb movements and cough. Patient 2 demonstrated no sternal separation or micro-motion post-operatively with cortical bone bridging the sternal edges.Conclusions: Real-time ultrasound is a non-invasive, valid and reliable measurement tool for quantification of sternal separation and micro-motion; monitoring of sternal healing and evaluation of sternal closure techniques. Future research investigating sternal closure in particular adhesive-enhanced closure is warranted in a larger population.

Evaluating the Clinical Equivalence of Truwax® and Ethicon® Bone Waxes for Sternal Wound Hemostasis: A Prospective Randomized Study

“…Postoperative bleeding/oozing from the surgical site was clinically assessed, and the number of dressing changes was noted. The Sternal Instability Scale (0 is "clinically stable sternum" and 3 is "completely separated sternum") was used to assess the stability of the sternum [11]. Sternal bone instability was only confirmed by chest radiography at the investigator's discretion.…”