Clinical and Radiographic Evaluation of a Median Sternotomy Technique in the Dog

Abstract

This study evaluated postoperative sequelae following a sternotomy closed with transsternal and parasternal sutures in nine dogs. Wound complications noted within 30 days suggested excessive intraoperative trauma to bone or surrounding soft tissues. Radiographic evaluation at the end of this period demonstrated a significant lack of osseous bridging between the sternal halves in eight of nine dogs. There was frequent wire breakage, suggesting instability of the sternal halves and considerable midline inaccuracy when splitting the sternum. Postoperative pain was minimal. This technique is suitable for use in dogs provided that swaged‐on needles and sufficient transsternal wires are used, the sternebrae are carefully split on the midline, and the wires are carefully twisted to assure a tight closure.

Complications after thoracic surgery: don't (necessarily) blame it on the approach

“…It is interesting to note that median sternotomy was critically evaluated in clinical peer‐reviewed studies (Bright et al . , Burton & White ), much earlier than lateral thoracotomy (Moores et al . ).…”

Factors influencing the short‐term outcome following thoracic surgery in 98 dogs

“…Previously reported thoracotomy wound complications include incisional oedema, seroma, haemorrhage, skin dehiscence, wound discharge, infection, unstable sternal repair, displaced sternebrae and osteomyelitis (Bright and others 1983, Ringwald and Birchard 1989, Williams and White 1993, Burton and White 1996, Pelsue and others 2002). The reported incidence of such wound complications ranges from 19 to 56 per cent for MS and 36 per cent for IT (Bright and others 1983, Ringwald and Birchard 1989, Burton and White 1996, Pelsue and others 2002). Short‐term postoperative complications developed in 39 per cent of dogs reported here.…”

“…The authors consider the high complication rate following thoracic surgery for the treatment of pyothorax to be due, in part, to MS being the preferred surgical approach for this condition rather than simply being a result of the underlying pathology; a complication rate of 66 per cent was recorded in cases undergoing MS for conditions other than pyothorax and high complication rates of 40 to 56 per cent have been previously reported following MS in experimental dogs in the absence of disease (Bright and others 1983, Pelsue and others 2002). However, prospective studies are required to fully evaluate the true effect of the thoracotomy approach on postoperative wound complications in the absence of disease variables.…”

“…Several studies have looked at the technique and complications of median sternotomy (MS) in the dog and the cat (Bright and others 1983, Ringwald and Birchard 1989, Williams and White 1993, Burton and White 1996, Pelsue and others 2002), but there are few reports assessing outcome following thoracic surgery, which include other aspects of treatment such as pre‐operative diagnosis, choice of thoracic approach and placement of thoracic drains (TD).…”

Thoracic Surgery; Important Considerations and Practical Steps

“…Other issues noted were wound edema, seroma, hemorrhage, and mild wound dehiscence. 29 The combined wiring technique was used to minimize the potential for the transsternal wires for cutting through the thinner central sternebrae, resulting in instability and sternal dehiscence. Specific steps to reduce patient morbidity after sternotomy include dividing individual sternebrae along the midline and leaving 1 or 2 sternebrae intact at either end of the sternum to provide for better alignment and to minimize sternal shifting.…”