Does Elective Sternal Plating in Morbidly Obese Patients Reduce Sternal Complication Rates?

Tugulan, Carmen; Spindel, Stephen M.; Bansal, Aditya; Bates, Michael; Parrino, E.

doi:10.1016/j.athoracsur.2020.04.027

Cited by 10 publications

(10 citation statements)

References 24 publications

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“…Some studies showed that rigid plate fixation is superior to wire closure [Nenna 2019;Allen 2017]. However, other studies were unsuccessful in demonstrating this difference [Alhalawani 2013;Tugulan 2020;Snyder 2009]. The plate cannot be firmly affixed to the sternum using a screw in patients with fragile cortical bones.…”

Section: Discussionmentioning

confidence: 99%

The Simple Technique of Sternal Closure Using An Absorbable Mesh Plate

Watanuki

Futamura

Tochii

et al. 2022

HSF

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Background: Several authors have investigated various sternal closure materials and technologies for sternal fixation; nonetheless, the optimal technique for primary sternal closure remains unclear. This study aimed to evaluate the sternal stability of a simple technique using a mesh-type plate (Super Fixorb MX40®; Takiron Co. Ltd., Osaka, Japan), as compared with wire cerclage. Methods: A total of 70 patients who underwent cardiovascular surgery through median sternotomy between July 2019 and May 2020 were included. Two pieces of mesh-type plates were placed under the sternum in combination with wiring. The technique for sternal closure was randomly applied, which was mainly based on the surgeon’s preferences: mesh plate (mesh group: N = 33) or conventional wire cerclage (wire group: N = 37). Sternal displacement was measured using computed tomography at discharge. Results: Pain scale scores and analgesic use on postoperative day 7 were similar between the two groups. However, the displacement in both the anterior-posterior and lateral directions was significantly smaller in the mesh group. Conclusions: The use of the mesh plate device for sternal closure is simple, safe, easy, and potentially reliable without anterior-posterior sternal displacement.

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Section: Discussionmentioning

confidence: 99%

The Simple Technique of Sternal Closure Using An Absorbable Mesh Plate

Watanuki

Futamura

Tochii

et al. 2022

HSF

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“…Bejko et al found no differences between the ICU stay periods of the patients that were closed with nitinol clips alone and the patients that were closed with steel wire (24). Although Tulugan et al found no differences in sternal complications in their study including 564 patients where they compare nitinol clips combined steel wire closure and steel wire closure alone, they found shorter hospital stay periods in nitinol clips group (25). We found no differences between three groups regarding ICU stay (p=0.972) and hospital stay periods (p=0.684) as similar to other studies.…”

Section: Discussionmentioning

confidence: 96%

“…Allen et al found that the risk of sternal dehiscence and sternal wound infection were decreased by using the rigid sternal plate fixation in their randomized controlled study (26). Many studies reported that, using rigid sternal plate or nitinol clips for closure of the sternum prevents the development of sternal dehiscence and wound complications (7,17,18,24,25). In our study, we evaluated one superficial wound infection in TSCP group, but there was no sternal dehiscence among the groups that were closed with TRC/TSCP combined steel wire.…”

Section: Discussionmentioning

confidence: 99%

Sternal Komplikasyon Riski Yüksek Hastalarda İlk Sternotomi Kapamalarında Çelik Tel İle Sternal Kapatma Sistemlerinin Kombinasyonu: Termoreaktif Nitinol Klips Mi? Titanyum Sternal Kapatma Plağı Mı?

Çelik¹,

Çora²,

Gülmen

2022

Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi

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Amaç: Bu çalışmada ilk sternotomilerin kapatılmasında kullanılan geleneksel çelik tel yöntemi, bu yöntem ile kombine edilen termoreaktif nitinol klips (TNK) ve titanyum sternal kapatma plağı (TSKP) kullanımı sonrası gelişebilecek sternal komplikasyon oranları karşılaştırıldı. Çalışma planı: Mayıs 2018 – Ekim 2020 tarihleri arasında median sternotomi ile açık kalp cerrahisi uygulanan toplam 210 hasta ( 153 erkek, 57 kadın; ortalama yaş 62,87±10.21; dağılım 21-86 yıl) geriye dönük olarak incelendi. Hastalar sade çelik tel uygulanan (n=179), çelik tel ile TNK uygulanan (n=17) ve çelik tel ile TSKP uygulanan (n=14) olmak üzere üç gruba ayrıldı. Gruplar arasında demografik, klinik özelliklere ve postoperatif sternal komplikasyon oranları karşılaştırıldı. Bulgular: Saddecegeleneksel çelik tel yöntemi ile sternotomisi kapatılan toplam 2 hastada (%1.1) sternal dehisens, toplam 2 hastada (%1.1) yüzeyel cilt enfeksiyonu gelişti. Çelik tel ile TSCP’nin kombine edildiği grupta ise 1 hastada (%7.1) yüzeyel cilt enfeksiyonu saptandı. TNK ve TSCP kullanılan gruplarda sternal dehisens izlenmedi. TNK ve TSKP kullanılan gruplarda diyabet oranı yüksek saptandı (p=0.002). Hastalar vücut kitle indekslerine (VKİ) göre dört gruba ayrıldı. TNK ve TSKP kullanılan hastalarda 35-39,9 ve >40 kg/m2 VKİ oranları anlamlı saptandı (p

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“…And, these plates have the disadvantages of taking extra time to insert and of adding to the difficulty of rapid re-entry, should that become necessary. [Pinotti, 2018, Tugulan 2020…”

Section: Closing the Sternotomy: Part I Heavy Metalmentioning

confidence: 99%

The Median Sternotomy: The Unkindest Cut of All? Pearls, Pitfalls, Aphorisms, & Myths

Tribble

Merrill

Derryberry

et al. 2021

HSF

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While some have claimed that a median sternotomy is an ‘unkind cut,’ when this incision is performed, closed, and managed optimally, it can be one of the ‘most kind cuts’ used for major operations. The median sternotomy is the most commonly used incision for coronary artery bypass surgery, which is the most common operation performed in the United States at the current time. This approach is, of course, used for many other cardiac and thoracic operations, as well. It is, however, also one of the most misunderstood procedures in Surgery. Because it is an incision that even a novice surgical resident can perform, with proper supervision, the subtleties and nuances of not only opening but also of closing sternotomies are not often conveyed optimally to our trainees. In this treatise we will attempt to comprehensively address these subtleties, nuances, and misunderstandings, both for the benefit of our younger learners, but also, and more importantly, for the benefit of our patients.

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Does Elective Sternal Plating in Morbidly Obese Patients Reduce Sternal Complication Rates?

Cited by 10 publications

References 24 publications

The Simple Technique of Sternal Closure Using An Absorbable Mesh Plate

The Simple Technique of Sternal Closure Using An Absorbable Mesh Plate

Sternal Komplikasyon Riski Yüksek Hastalarda İlk Sternotomi Kapamalarında Çelik Tel İle Sternal Kapatma Sistemlerinin Kombinasyonu: Termoreaktif Nitinol Klips Mi? Titanyum Sternal Kapatma Plağı Mı?

The Median Sternotomy: The Unkindest Cut of All? Pearls, Pitfalls, Aphorisms, & Myths

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