Reinforced closure of the sternum with absorbable pins for high-risk patients

Abstract

We report our result of the reinforced sternal closure in 51 consecutive patients. We applied a new type of absorbable radiopaque pins (Super FIXSORB) composed of poly-lactide acid and hydroxyapatite, in addition to conventional stainless steel wires. The risk scores of our patients were calculated from the simplified risk scoring system for major infection based on the Society of Thoracic Surgeons National Cardiac Database. The expected probability of infection is significantly higher than the actual infection rate in our patients. Our procedure may contribute to minimizing the fatal sternal complication particularly in high-risk patients.

Deep Sternal Wound Complications: An Overview of Old and new Therapeutic Options

“…31,32 There have been many more suggestions in the literature, including the addition of absorbable pins, but none has been proven to be superior to all others. [33][34][35][36][37][38] As more wires provide more stability, obese patients are frequently treated with a higher number of wires or with sternal bands if the bone is sufficiently robust. 39,40 In patients with extraordinary osteoporosis, wires easily tear through the fragile bone.…”

Effects of Polyglyconate (Maxon) Suture Reinforced Sternum Closure Technique on Aseptic Sternal Dehiscence in High Risk Patients

“…Luciani et al used polydiaxanone suture alone in high risk patients and addressed lower incidence of aseptic dehiscence then conventional wire sutured patients (14) . Hamaji et al studied reinforced closure of the sternum with absorbable pins for high-risk patients, and decreased sternal complications (5) .…”

“…Thus, reinforced sternal closure for prevention of sternal dehiscence in high-risk patients is necessary (3)(4)(5)(6) . In our study, we placed 4 to 6 (average 5) polyglyconate (Maxon) sutures additionally to intercostal spaces besides conventional three or four fi gure-eight wire sutures in these selected 136 high risk patients and observed whether sternal dehiscence occurs.…”

Analysis of the sternum for sternal closure with bioabsorbable sternal pins

“…Recently, bioabsorbable sternal pins, which are made of poly-L-lactide, have been applied in addition to the conventional stainless steel wiring, and their effectiveness in reducing sternal wound complications has been reported. 4,5 However, we occasionally experience a small sternum for the use of sternal pins, and, in fact, we recently encountered a case of local sternal dehiscence caused by too long a sternal pin ( Figure 1). Although sternal pins are inserted into the sternal bone marrow, features of the sternum such as the size itself or its relation to sex or body size have not yet been fully investigated.…”