Interlocking figure-of-8 closure of the sternum

Marco, Ritt; Lee, M.W.; Bekoe, Seth; Grant, Kathleen J.; Woelfel, George F.; Pellegrini, Ronald V.

doi:10.1016/0003-4975(89)90042-8

Cited by 48 publications

(20 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, variations of this technique have also been used in primary closure. These have included the use of parallel wires twisted together in the longitudinal axis and again in the transverse axis [20], the use of peristernal criss-cross wires [21], and the combination of lateral reinforcement together with the use of figure-of-eight sutures [22].…”

Section: Discussionmentioning

confidence: 99%

Modified closure technique for reducing sternal dehiscence; a clinical and in vitro assessment

John

2008

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Modified closure technique for reducing sternal dehiscence; a clinical and in vitro assessment

John

2008

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…More than 40 different techniques with various materials have been described for sternal closure [12][13][14][15][16] . Most techniques revolve around a different pattern of wire cerclage, rigid plate fixation, or various non-rigid methods of closure [29][30][31][32][33][34][35][36] . The techniques those provide more rigid fixation are associated with relatively fewer wound infection and even mortality [3] .…”

Section: Discussionmentioning

confidence: 99%

Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

Küçükdurmaz

Ağır²,

Bezer³

2013

WJO

View full text Add to dashboard Cite

AIM:To increase the stability of sternotomy and so decrease the complications because of instability. METHODS:Tests were performed on 20 fresh sheep sterna which were isolated from the sterno-costal joints of the ribs. Median straight and interlocking sternotomies were performed on 10 sterna each, set as groups 1 and 2, respectively. Both sternotomies were performed with an oscillating saw and closed at three points with a No. 5 straight stainless-steel wiring. Fatigue testing was performed in craniocaudal, anterio-posterior (AP) and lateral directions by a computerized materials-testing machine cycling between loads of 0 to 400 N per 5 s (0.2 Hz). The amount of displacement in AP, lateral and craniocaudal directions were measured and also the op- posing bone surface at the osteotomy areas were calculated at the two halves of sternum. BRIEF ARTICLE RESULTS:The mean displacement in cranio-caudal direction was 9.66 ± 3.34 mm for median sternotomy and was 1.26 ± 0.97 mm for interlocking sternotomy, P < 0.001. The mean displacement in AP direction was 9.12 ± 2.74 mm for median sternotomy and was 1.20 ± 0.55 mm for interlocking sternotomy, P < 0.001. The mean displacement in lateral direction was 8.95 ± 3.86 mm for median sternotomy and was 7.24 ± 2.43 mm for interlocking sternotomy, P > 0.001. The mean surface area was 10.40 ± 0.49 cm² for median sternotomy and was 16.8 ± 0.78 cm² for interlocking sternotomy, P < 0.001. The displacement in AP and cranio-caudal directions is less in group 2 and it is statistically significant. Displacement in lateral direction in group 2 is less but it is statistically not significant. Surface area in group 2 is significantly wider than group 1. CONCLUSION:Our test results demonstrated improved primary stability and wider opposing bone surfaces in interlocking sternotomy compared to median sternotomy. This method may provide better healing and less complication rates in clinical setting, further studies are necessary for its clinical implications.

show abstract

“…The most important factor in the prevention of sternal events is a stable sternal approximation following sternotomy [8,9]. There have been many attempts to improve upon the standard method of steel wire cerclage, but these systems have failed to gain widespread adoption due to practicality or excessive cost.…”

Section: Introductionmentioning

confidence: 99%

Prospective, randomized, single blinded pilot study of a new FlatWire based sternal closure system

Boustany

Ghareeb

Lee

2014

J Cardiothorac Surg

View full text Add to dashboard Cite

BackgroundUnstable steel wire cerclage following open heart surgery may result in increased pain, sternal cut-through, non-union, or dehiscence. These complications lead to longer hospital stays, increased cost, higher morbidity, and patient dissatisfaction. The Figure 8 FlatWire Sternal Closure System is a new construct which is a simple, intuitive, and inexpensive alternative for primary sternal repair following open heart surgery. Prior bench-top testing of FlatWire has demonstrated superior strength and stiffness compared to traditional steel wire. We present our initial experience in a prospective, randomized, single blinded pilot study utilizing this FDA approved system.MethodsSixty-three patients undergoing elective complete sternotomies at a single institution were randomly assigned to receive either the Figure 8 FlatWire or standard steel wire cerclage. All surgeries were performed by a single board certified cardiothoracic surgeon. Data collected included: Age, BMI, pump time, off pump to surgical stop time, length of hospital stay after surgery, cost from time of surgery to discharge, and pain on a visual analog pain scale on the day of discharge, day 30, and day 60.ResultsThe groups were well matched. Patients receiving the Figure 8 FlatWire (33) had a reduction in length of stay compared to patients receiving steel wire circlage (30), but it was not statistically significant (6.8 vs. 7.8 days respectively, p < 0.093). Additionally those with the FlatWire reported significantly decreased pain at day of discharge (3.07 vs. 4.92 points on pain scale, p < 0.0066), with similar pain scores at 30 and 60 days. Off pump to surgery stop time was increased by 15.9 minutes in patients receiving the FlatWire vs. steel wires (55.7 vs. 71.6 minutes, p = 0.00025). Mean cost from surgery until discharge was $87,820.98 in the FlatWire group vs. $91,930.29 in the steel wire group (p < 0.3082).ConclusionEarly clinical results suggest that Figure 8 FlatWire provides excellent stability, which resulted in significantly diminished postoperative pain at discharge. Although not significant there was a trend toward decreased length of stay, and reduced cost. Further clinical research is warranted to expand upon these initial trends and validate long term outcomes.

show abstract

Interlocking figure-of-8 closure of the sternum

Cited by 48 publications

References 11 publications

Modified closure technique for reducing sternal dehiscence; a clinical and in vitro assessment

Modified closure technique for reducing sternal dehiscence; a clinical and in vitro assessment

Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

Prospective, randomized, single blinded pilot study of a new FlatWire based sternal closure system

Contact Info

Product

Resources

About