Vitalitec International, The Sternal Closure Device: A novel closure technique for sternal dehiscence

Abstract

Objective: Impaired sternal wound healing remains problematic after median sternotomy and can cause to significant morbidity after cardiac surgical procedures. Although some reconstruction systems exist for sternal closure, their use is limited by expense and practicality, and simple wire closure remains the most common technique to close the sternum. In this study, we aim to discuss the results of 6 cases that underwent surgery for sternal dehiscence(SD). Methods:We reviewed six patients with sternal dehiscence who underwent surgery in our department between April 2013 and May 2014. We have used a novel closure technique in six patients with sternal dehiscence and evaluated early-term results of sternal clips plus rewiring following failed sternal closure. Results:The mean age was 63 (range, 55 to 79 years). All patients were male. We have used a novel closure technique with sternal clips plus rewiring in all patients. We evaluated six patients with non-infectious SD. Sternal reconstruction using rigid fixation with clips improve bone healing and reduce early postoperative pain. All cases were discharged with successful treatment. Conclusions:We believe that this method of sternal closure guarantees better clinical outcomes rather than sternal wire closure. Additionally, SCD(sternal closure device) clips proved to be cost effective in cardiac surgery. J Clin Exp Invest 2014; 5 (4): 534-538Key words: Sternal dehiscence, closure technique, cardiac surgery ÖZET Amaç: Median sternotomi sonrası bozulmuş sternal yara iyileşmesi kardiak cerrahi sonrası önemli morbidite sebebi olabilir. Sternum kapatılması için bazı teknikler mevcut olmasına rağmen pratikte sınırlıdır ve sternumu basit tel tekniği ile kapatma uygulanan en yaygın tekniktir. Bu çalışmada sternal ayrılma nedeniyle cerrahi uygulanan 6 olgunun sonuçlarını tartışmayı hedefliyoruz. Sonuç: Sternumun bu yöntem ile kapatılmasının tel ile kapatılmasına göre daha etkin ve daha iyi klinik sonuçlar verdiğine inanıyoruz, ayrıca kalp cerrahisinde sternal kapama klipslerin kullanılması daha düşük maliyetli olduğu görülmüştür.

Comparison of Sternum Closure Techniques with Sternal Cable and Simple Wire After Open Heart Surgery

“…Although the simple wire method is the most commonly used sternum closure technique today, new methods can be used for sternal reconstruction instead of conventional simple wire. In complicated cases such as multiple sternal fractures, infections, postoperative dehiscence, reoperations or osteoporosis another technique might be useful (1,(8)(9)(10)(11)(12)(13). In our study, sternal dehiscence developed in both groups, and re-wiring was performed using sternal cable for all these patients.…”

“…With the increase in the average life span, there is also an increase in cardiac diseases. Though there is an increase in minimally invasive methods in open heart surgery, the most commonly used incision method is median sternotomies (1,2). As a result of the complications that could occur in the superficial or deep sternal areas in the region and could lead to a significant cost increase, it has come across with both increased mortality and morbidity.…”

“…Nowadays as the average life span increases, cardiovascular disease rates are also on the rise. Therefore, there is an increase in minimally invasive methods for open heart surgery, and the most commonly used incision is median sternotomy (1,2). In the early 1960s, Julian's median sternotomy was successfully performed in cardiovascular surgery (3).…”

“…However, the development of sternal dehiscence after median sternotomy can be predicted in the presence of various risk factors. These risk factors include obesity, chronic renal failure (CRF), chronic obstructive pulmonary disease (COPD), smoking, internal mammary artery (IMA) grafting, long cardiopulmonary bypass (CPB) duration, excess blood transfusion, inappropriate fixation methods and osteoporosis (1).…”