A novel modified Robicsek technique for sternal closure: “Double-check”

Lafçı, Gökhan; Yaşar, Emre; Çiçek, Ömer Faruk; İrdem, Ahmet; Uzun, Alper; Yalçınkaya, Adnan

doi:10.1177/0218492313497207

Cited by 7 publications

(8 citation statements)

References 7 publications

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“…4,14 Tang et al treated 15 patients with sternotomy infection using VAC and succeeded, with only two mortality from complications of sepsis. 15 In our case, the use of negative pressure of 125 mmHg as induction therapy was conducted continuously for 48 hours and continued intermittently at the lowest threshold level of 75 mmHg. 10,15 The clinical response was found to be good and satisfactory.…”

Section: Case Reportmentioning

confidence: 87%

“…13 Some modifications of the Robicsek technique are still the gold standard in high-risk patients. 14,15 The Robiscek technique is often used to strengthen the sternum during primary sternal closure, where the sternotomy crosses the medial line and results in a thin and weak sternum on one side, or where the bone fracture has occurred and is also used as the first line of sternal reconstruction after primary closure dehiscence. 15,16 In patients with an increased risk of sternal instability and wound infection following cardiac surgery, 17 sternal strengthening using the Robicsec technique is performed before primary sternal closure to not reduce the dehiscence rate.…”

Section: Case Reportmentioning

confidence: 99%

“…14,15 The Robiscek technique is often used to strengthen the sternum during primary sternal closure, where the sternotomy crosses the medial line and results in a thin and weak sternum on one side, or where the bone fracture has occurred and is also used as the first line of sternal reconstruction after primary closure dehiscence. 15,16 In patients with an increased risk of sternal instability and wound infection following cardiac surgery, 17 sternal strengthening using the Robicsec technique is performed before primary sternal closure to not reduce the dehiscence rate. 16,18 Studies conducted in the last decade by Morykwas et al suggested that the use of negative pressure therapy or VAC in highly infectious wounds, especially in the sternum, is able to give excellent results.…”

Section: Case Reportmentioning

confidence: 99%

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Management of a rare case of pediatric deep sternal wound infection with vacuum-assisted closure (VAC)

Ramli

Kusumaputri²,

Prabowo³

et al. 2022

JRE

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Background: Deep sternal wound infection (DSWI) or mediastinitis is a severe and life-threatening infection with high morbidity and mortality rates. Vacuum-assisted closure (VAC) provides good results and is very useful in wound closure. VAC therapy is a safe and affordable method for managing complex sternal and thoracic injuries. The use of VAC has been shown to increase parasternal blood flow by dilating arterioles, reducing bacterial load, and accelerating granulation tissue formation. It also helps with facilitating wound edge closure. Case and Operation Technique: A 6-month-old baby presented with an ulcer 2 cm deep in the thorax region. The wound had an exposed bone surrounded by slough and hyperemic edges. Bone destruction was seen to have reached the costochondral joint with a gross visible appearance of the pleura. Management of this patient included debridement, sternotomy, internal fixation of the sternum using the Robiscek technique, and application of the Water Shield Drainage (WSD) and VAC. The tobacco-sack technique was used to close the open wound. The Robiscek technique was used in this patient because of the bone destruction to the costochondral joints causing the sternum to become unstable. The VAC dressing was then connected to a suction with an intermittent negative pressure of 75mmHg. After a significant decrease in the wound surface area, a local rotational flap was used to close the wound. Conclusion: The use of modified VAC for deep sternal wound infection (DSWI) is effective, simple, and affordable with minimal complications.

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Section: Case Reportmentioning

confidence: 87%

Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

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Management of a rare case of pediatric deep sternal wound infection with vacuum-assisted closure (VAC)

Ramli

Kusumaputri²,

Prabowo³

et al. 2022

JRE

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“…Some authors simplified this technique, 10 and others made it more complex. 20 Besides increasing surgical time, this technique is not free of complications because it can lead to increased bleeding and pseudoaneurysms in the internal thoracic artery. 21 This complication is rare and may occur in standard closure, but as in the Robicsek method more steel wires are passed, and the probability becomes greater.…”

Section: Discussionmentioning

confidence: 99%

Closure of the sternum with anchoring of the steel wires: Systematic review and meta-analysis

Pinotti

Catâneo

Rodrigues

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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Video clip is available online.Standard closure after median sternotomy reapproximates the sternum using steel wires with a simple suture technique or figure of 8 configuration (Video 1). However, this closure technique has been associated with several serious complications that have prompted surgeons to look for new closure methods. These complications include sternal instability, dehiscence, and mediastinitis as a result of bone nonconsolidation or bone disruption caused by steel wires. These conditions represent the major causes of morbidity and mortality after cardiac surgery. 1 Infection rates after median sternotomy vary from 0.2% to 10%, and in cases of infection, morbidity, and mortality, rates vary from 5% to 25%. 2 The incidence of postoperative complications is more frequent with the following risk factors: thoracic radiation, obesity, diabetes, osteoporosis, chronic lung disease, immunosuppression, renal failure, hypertension, advancing age, and chronic use of corticosteroids. [3][4][5][6] New strategies for the closure of median sternotomies are being sought to minimize the incidence of complications. However, an optimal technique has yet to be established. 7,8 Several alternative methods have been developed. Some are based on the anchoring of the steel wires to prevent rupture of the sternal bone. The first method, described in 1977, 9 consists of passing parasternal continuous wire suture alternately in front of and behind the costal cartilages, leaving them within the usual parasternal sutures (Figure 1, A). This technique can be simplified: the steel wires placed on both sides of the sternum, anterior, and posterior in the alternating costal cartilages, so that both ends of the wire From the a Program on General Basis of

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“…Robicsek Technique provided excellent sternal approximation after reoperation for sternal dehiscence 18 .…”

Section: Schimmer Et Al Documented In There Study Thatmentioning

confidence: 99%

Frequency of Unidentified Diabetes Mellitus in Patients With Acute Myocardial Infarction

Rashdi

Ali

Ahmed

et al. 2021

PAFMJ

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Objective: To determine the frequency of unidentified Diabetes Mellitus in Acute Myocardial Infarction. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Army Cardiac Centre Lahore, Lahore, from Jan 2020 to Feb 2020. Methodology: Patients (male and females) with acute myocardial infarction both ST Elevation MI and non-ST Elevation MI presenting to cardiac centre were included through consecutive non probability sampling technique. Patients with gestation diabetes mellitus and diabetes type I were excluded. Data was collected through detailed questionnaire covering the necessary variables. Distribution of unrecognized diabetes in these patients were determined through Blood Sugar Fasting and HBA1c levels undersigned by the classified Pathologist. Results: Over the study period, a total of 150 patients were included. 68.6% were males with 40.6% patients suffering from STEMI and 28% with NSTEMI. Among 31.2% females, 12.6% patients had STEMI and 18.6% had NSTEMI. Out of total patients, 40% were known case of diabetes, 26.6% were newly diagnosed diabetics, normoglycemic were 23.3% and impaired fasting blood glucose levels was present in 10% patients. Total 40 (26.6%) patients were those who were first diagnosed diabetes during admission for acute MI management. In unidentified diabetic group STEMI was more common than NSTEMI with male predominance. Conclusion: There is a high frequency of unrecognized diabetes mellitus in patients with acute Myocardial infarction in our population. Therefore, in high risk patients for ischemic heart disease, screening for diabetes is routinely suggested to take timely preventive efforts and avoid complications.

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A novel modified Robicsek technique for sternal closure: “Double-check”

Cited by 7 publications

References 7 publications

Management of a rare case of pediatric deep sternal wound infection with vacuum-assisted closure (VAC)

Management of a rare case of pediatric deep sternal wound infection with vacuum-assisted closure (VAC)

Closure of the sternum with anchoring of the steel wires: Systematic review and meta-analysis

Frequency of Unidentified Diabetes Mellitus in Patients With Acute Myocardial Infarction

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