Biomechanical comparison of median sternotomy closures

Losanoff, Julian E.; Collier, Andrea D; Wagner‐Mann, Colette C.; Richman, Bruce W.; Huff, H. E.; Hsieh, Fu hung; Diaz-Arias, Alberto A.; Jones, James W.

doi:10.1016/s0003-4975(03)01468-1

Cited by 102 publications

(81 citation statements)

References 17 publications

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“…If wires cut into the sternum after they are tied, sutures will loosen, the sternum halves will first moderately separate, and then, due to respiratory motion of the chest wall, the loose wires will literally cut the sternum into segments. 28 Despite current improvements in operative techniques, anesthesia, and antibiotic treatments, sternal dehiscence and mediastinitis, arising from uncomplete repair, are among the most severe complications of median sternotomy, remaining a significant source of mortality and morbidity, 7,20,42 especially in the presence of predisposing factors determining poor bone quality as old age, osteoporosis, diabetes, obesity, steroid treatment, reoperation, early postoperative resuscitation, and use of bilateral thoracic arteries. 18 In this scenario, characterized by limited and controlled tissue loss, the use of biomaterials could be a valid alternative to promote and improve bone repair.…”

Section: Discussionmentioning

confidence: 99%

Electrospun Hydroxyapatite-Functionalized PLLA Scaffold: Potential Applications in Sternal Bone Healing

et al. 2011

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Sternal synthesis after median sternotomy, a conventional access practice in thoracic and cardiac surgery, is at the basis of severe complications, often impairing the clinical outcome of surgical interventions. In this work, we propose the use of an acellular biomaterial scaffold, to be interposed across the fracture rime during closure operations, directly exposing the biomaterial to bone marrow, in order to expedite healing process. A rabbit model of median sternotomy was performed and an electrospun scaffold composed of a hydroxyapatite-loaded absorbable biopolymer (poly-L: -lactide), shaped into a fibrillar structure, was used. CT follow-up confirmed a complete healing in the scaffold-treated group 1 week before the control. Histological evaluation demonstrated presence of newly formed bone trabeculae among scaffold fibers showing a higher degree of maturity with respect to the control untreated group. The proposed approach is able to both guide a more rapid healing and modulate inflammatory response across the wound site, resulting in improved healing and tissue remodeling with respect to conventional closure technique.

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Section: Discussionmentioning

confidence: 99%

Electrospun Hydroxyapatite-Functionalized PLLA Scaffold: Potential Applications in Sternal Bone Healing

et al. 2011

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“…On the other hand, the initial instability derives from the basic mechanism of an osteomyelitis: this is the ground upon which the feared infection develops [32]. Experimental studies compared the mechanical stability of the sternum using a variety of wiring techniques and other sternotomy closure material [33,34]: several methods of sternal closure have been described in literature, for example, additional steel band at the third intercostal space [35], double crisscross [36], and double wires [32]. Measurement focusing on increased intrathoracic pressure showed a sternal separa- tion of 2 mm at 46.8 mmHg of pressure: strong coughing during extubation periods or postoperative course increases the intrathoracic pressure to 300 mmHg [37].…”

Section: Discussionmentioning

confidence: 99%

Posthorax<sup>®</sup> Prevents Sternal Dehiscence and Instability: Preliminary Results of a Prospective Randomized Multicenter Trial

Santarpino¹,

Fischlein²,

Pfeiffer³

2013

OJTS

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Aim: A Prospective Randomized Multicenter Trial is ongoing to evaluate Posthorax and prevention of sternal dehiscence/instability: clinical percept is optimistic for Posthorax use. The aim of this mono-center analysis is to give a preliminary result of Posthorax support vest after sternotomy. Methods: One hundred and eighty three cases elective patients were consecutive operated and included in this study conducted in our department since June 2009. Patients were randomized as following: 68 patients were treated with the Posthorax support vest and 115 received a standard bandage postoperatively. The primary endpoints were the Infective Events. Secondary endpoints included a composite of postoperative clinical variables and mortality. Results: The two groups are homogeneous for these characteristic except sex (more women in Control Group, p = 0.022). Operative data were comparable in both groups. Deep sternal infections occurred in four patients, all in Control Group (3.5% vs 0%, p = 0.153). At Follow up, we recorded 2 cases of superficial infection in the control group versus 0 (1.7%, p = 0.394) and 1 case of wound dehiscence always in Control Group versus 0 (0.9%, p = 0.628). Cumulative Infective Events are statistically more in Control Group (7 cases 6.1% versus 0 cases, p = 0.036 * ). According to the secondary endpoints, there were also no differences between the two compared groups except length of hospitalization (10.6 ± 4 days versus 13.4 ± 9.5, p = 0.019 * ). Conclusion: Preliminary results show the Posthorax sternum support vest as a valuable adjunct to prevent sternum-related complications: We record a statistical reduction of length of hospital stay and infective events using the support vest in a 3-month follow-up.

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“…Sternal union requires dependable biomechanical fixation. It is recognized that optimal sternal stabilization prevents the incidence of DSWI [13]. An unstable surgical wound, usually attributable to a technical fault, is a recognized risk factor for wound infection [14].…”

Section: Discussionmentioning

confidence: 99%

Does the number of wires used to close a sternotomy have an impact on deep sternal wound infection?

Shaikhrezai

Robertson

Anderson

et al. 2012

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES:We studied the influence of the number of sternotomy mechanical fixation points on deep sternal wound infection (DSWI). METHODS:Between September 2007 and February 2011, 2672 patients underwent a standard peri-sternal wire closure following a median sternotomy for a first-time cardiac surgery. Data were collected during the study period. RESULTS:The mean age of the patients was 66 ± 11 and 1978 (74.0%) were male. The mean body mass index (BMI) was 28.9 ± 9.3 and the median of the logistic EuroSCORE was 3.14, with a range of 0.88-54.1. Postoperatively, 40 (1.5%) patients developed DSWI after 14 ± 6 days, of whom 39 (92.5%) had positive deep sternal wound specimen cultures, predominantly Staphylococci (62.5%). The risk of DSWI was significantly increased in patients in whom eight or fewer paired points of sternal wire fixation were used when compared with patients in whom nine or more paired points of fixation were used (P = 0.002). Preoperative myocardial infarction (P = 0.001), elevated BMI (P = 0.046), bilateral internal mammary artery harvest (P < 0.0001), postoperative hypoxia (P < 0.0001), sepsis (P = 0.019) and postoperative inotrope use (P = 0.007) significantly increased the risk of DSWI.CONCLUSIONS: DSWI is associated with hypoxia, ischaemia, sepsis and mechanical sternal instability. DSWI may be prevented by using nine or more paired fixation points when closing with standard peri-sternal wires.

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Biomechanical comparison of median sternotomy closures

Cited by 102 publications

References 17 publications

Electrospun Hydroxyapatite-Functionalized PLLA Scaffold: Potential Applications in Sternal Bone Healing

Electrospun Hydroxyapatite-Functionalized PLLA Scaffold: Potential Applications in Sternal Bone Healing

Posthorax<sup>®</sup> Prevents Sternal Dehiscence and Instability: Preliminary Results of a Prospective Randomized Multicenter Trial

Does the number of wires used to close a sternotomy have an impact on deep sternal wound infection?

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Biomechanical comparison of median sternotomy closures

Cited by 102 publications

References 17 publications

Electrospun Hydroxyapatite-Functionalized PLLA Scaffold: Potential Applications in Sternal Bone Healing

Electrospun Hydroxyapatite-Functionalized PLLA Scaffold: Potential Applications in Sternal Bone Healing

Posthorax&lt;sup&gt;&#174;&lt;/sup&gt; Prevents Sternal Dehiscence and Instability: Preliminary Results of a Prospective Randomized Multicenter Trial

Does the number of wires used to close a sternotomy have an impact on deep sternal wound infection?

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Posthorax<sup>®</sup> Prevents Sternal Dehiscence and Instability: Preliminary Results of a Prospective Randomized Multicenter Trial