Adhesive-Enhanced Sternal Closure: Feasibility and Safety of Late Sternal Reentry

Spooner, Aaron J.; Mewhort, H.E.; DiFrancesco, Lisa M.; Fedak, Paul W.M.

doi:10.1155/2017/8605313

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…The most tried product as an alternative/supportive to steel wires is castor oil-based Kryptonite bone cement. Although many studies have stated that Kryptonite is safe, reliable, effective, and quick, it is no longer available on the surgical market. ,, Another product developed as an alternative/supportive to steel wires is the hyperbranched poly (amino ester)-based nanocomposite adhesive reported by Zhang . Although the adhesive is reported to show good adhesion and mechanical properties, it does not meet the exact results as it has been tested in an ex vivo sternal model.…”

Section: Resultsmentioning

confidence: 99%

“…reported that Kryptonite bone cement, when combined with a standard wire cerclage, increases mechanical strength, prevents sternal dehiscence, reduces postoperative pain, and improves the quality of life after conventional cardiac surgery . In similar studies with Kryptonite, great advantages were also observed compared to steel wires, and it was determined that it prevents major sternal complications. ,− Kryptonite is a castor oil-based and US Food and Drug Administration (FDA)-approved polymeric bone cement. However, it is no longer available on the surgical market.…”

Section: Introductionmentioning

confidence: 99%

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Fast Curing Multifunctional Tissue Adhesives of Sericin-Based Polyurethane-Acrylates for Sternal Closure

Balcıoğlu

Noma

Ulu

et al. 2022

ACS Appl. Mater. Interfaces

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The use of wire cerclage after sternal closure is the standard method because of its rigidity and strength. Despite this, they have many disadvantages such as tissue trauma, operator-induced failures, and the risk of infection. To avoid complications during sternotomy and promote tissue regeneration, tissue adhesives should be used in post-surgical treatment. Here, we report a highly biocompatible, biomimetic, biodegradable, antibacterial, and UV-curable polyurethane-acrylate (PU-A) tissue adhesive for sternal closure as a supportive to wire cerclage. In the study, PU-As were synthesized with variable biocompatible monomers, such as silk sericin, polyethylene glycol, dopamine, and an aliphatic isocyanate 4,4′-methylenebis(cyclohexyl isocyanate). The highest adhesion strength was found to be 4322 kPa, and the ex vivo compressive test result was determined as 715 kPa. The adhesive was determined to be highly biocompatible (on L-929 cells), biodegradable, and antibacterial (on Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus bacteria). Finally, after opening the sternum of rats, the adhesive was applied to bond the bones and cured with UV for 5 min. According to the results, there was no visible inflammation in the adhesive groups, while some animals had high inflammation in the cyanoacrylate and wire cerclage groups. These results indicate that the adhesive may be suitable for sternal fixation by preventing the disadvantages of the steel wires and promoting tissue healing.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fast Curing Multifunctional Tissue Adhesives of Sericin-Based Polyurethane-Acrylates for Sternal Closure

Balcıoğlu

Noma

Ulu

et al. 2022

ACS Appl. Mater. Interfaces

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“…Ideal adhesives could either be biologically inert or guide the healing response as with a tissue engineering approach [53]: the same biomechanical design principles apply to minimizing stress concentrations for tissue engineered biomaterials at interfaces between soft and hard tissues. Current adhesive approaches to orthopedic repair primarily use bone cements (e.g., [54]), cyanoacrylate- [55, 56, 57, 58, 59] or methacrylate-based chemistries [60, 61, 62, 63], which may be appropriate for fracture repair but are significantly more stiff than desirable for tendon-to-bone repair. Furthermore, biocompatibility is limited unless all free acrylate moieties are consumed.…”

Section: Discussionmentioning

confidence: 99%

Enhanced tendon-to-bone repair through adhesive films

et al. 2018

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Current surgical techniques for tendon-to-bone repair have unacceptably high failure rates, indicating that the initial repair strength is insufficient to prevent gapping or rupture. In the rotator cuff, repair techniques apply compression over the repair interface to achieve contact healing between tendon and bone, but transfer almost all force in shear across only a few points where sutures puncture the tendon. Therefore, we evaluated the ability of an adhesive film, implanted between tendon and bone, to enhance repair strength and minimize the likelihood of rupture. Mechanical models demonstrated that optimally designed adhesives would improve repair strength by over 10-fold. Experiments using idealized and clinically-relevant repairs validated these models. This work demonstrates an opportunity to dramatically improve tendon-to-bone repair strength using adhesive films with appropriate material properties.

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“…Kryptonite™ can bond directly with bone and provides rigid bone fixation and stability which can in turn enhance sternal union and osteosynthesis. It resulted in early recovery after cardiac surgery without any side effects and also reduced the levels of pain marker, IL‐6 81–85 …”

Section: Progress In Enhancing Sternal Healing Controlling Bleedingmentioning

confidence: 99%

Recent developments in controlling sternal wound infection after cardiac surgery and measures to enhance sternal healing

Pradeep

Rangasamy

Varma

2020

Medicinal Research Reviews

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One of the major risks of cardiac surgery is the occurrence of infection at the sternal wound site. Sternal wound infections are primarily classified into superficial infection and deep sternal wound infection or mediastinitis. A patient is diagnosed with mediastinitis if microorganisms are present in their mediastinal tissue/fluid or with the observation of sternal wound infection during operation and with characteristic symptoms including chest pain, fever, and purulent drainage from the mediastinum. It is usually caused by Staphylococcal organisms in 75.8% of cases and the rest is caused by gram‐negative bacteria. Currently, in cardiac surgery, hemostasis is achieved using electrocautery and bone wax, and the sternum is closed using wire cerclage. Several studies show that bone wax can act as a nidus for initiation of infection and the oozing blood and hematoma at the site can promote the growth of infectious organisms. Many research groups have developed different types of biomaterials and reported on the prevention of infection and healing of the sternum. These materials are reported to have both positive and negative effects. In this review, we highlight the current clinical practices undertaken to prevent infection and bleeding as well as research progress in this field and their outcomes in controlling bleeding, infection, and enhancing sternal healing.

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Adhesive-Enhanced Sternal Closure: Feasibility and Safety of Late Sternal Reentry

Cited by 6 publications

References 7 publications

Fast Curing Multifunctional Tissue Adhesives of Sericin-Based Polyurethane-Acrylates for Sternal Closure

Fast Curing Multifunctional Tissue Adhesives of Sericin-Based Polyurethane-Acrylates for Sternal Closure

Enhanced tendon-to-bone repair through adhesive films

Recent developments in controlling sternal wound infection after cardiac surgery and measures to enhance sternal healing

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