Sternal force distribution during median sternotomy retraction

Aigner, Philipp; Eskandary, Farsad; Schlöglhofer, Thomas; Gottardi, Roman; Aumayr, Klaus; Laufer, Günther; Schima, Heinrich

doi:10.1016/j.jtcvs.2013.07.075

Cited by 8 publications

(6 citation statements)

References 31 publications

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“…Median sternotomy is reported as the preferred surgical approach to explore the thoracic cavity, 1,2 especially in case of pyothorax. In human medicine, this surgery is reported to be associated with significant postoperative pain caused by tissue injury at the level of the skin, subcutaneous tissues, bone, and cartilage 3 . Sternal retractors are frequently used during surgery and produce disruptive forces, not only around the surgical site itself, but also at the costovertebral joints and more distant sites, due to rib fractures at the level of costovertebral joints, costochondritis, rib joint dislocation or nerve injury 3 …”

Section: Introductionmentioning

confidence: 99%

“…In human medicine, this surgery is reported to be associated with significant postoperative pain caused by tissue injury at the level of the skin, subcutaneous tissues, bone, and cartilage. 3 Sternal retractors are frequently used during surgery and produce disruptive forces, not only around the surgical site itself, but also at the costovertebral joints and more distant sites, due to rib fractures at the level of costovertebral joints, costochondritis, rib joint dislocation or nerve injury. 3 Different strategies have been reported in both human and veterinary medicine to treat perioperative pain associated with thoracic surgery.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound‐guided parasternal block in a cat undergoing median sternotomy for pulmonary lobectomy

Degani

Dupont

Giansetto

et al. 2023

Vet Record Case Reports

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A 3.25-kg, 1-year-old, European shorthair cat was referred for acute respiratory distress. A thoracic computed tomography revealed the presence of multiple pulmonary abscesses, and a median sternotomy for pulmonary lobectomy was scheduled. The cat was premedicated with methadone and dexmedetomidine, anaesthesia was induced with alfaxalone and maintained with isoflurane in 100% oxygen. Ultrasound-guided parasternal block was performed before surgery with ropivacaine 0.5% (total dose 3 mg/kg). Rescue analgesia was needed only during abscess debridement and lung lobectomy. Postoperative pain was assessed every hour, using the short-form Glasgow Feline Composite Measure Pain Scale. The cat required rescue analgesia (0.2 mg/kg methadone) 7 hours after the completion of the block. This case report describes the feasibility of ultrasound-guided parasternal block in a cat undergoing median sternotomy, suggesting that it can usefully be added to a multimodal analgesic plan in the perioperative period.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ultrasound‐guided parasternal block in a cat undergoing median sternotomy for pulmonary lobectomy

Degani

Dupont

Giansetto

et al. 2023

Vet Record Case Reports

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“…However, despite 75 years of widespread use, mechanical analyses of Finochietto-style retractors and biomechanical studies of thoracic retraction are virtually nonexistent in the literature, despite the trauma which it generates. It is widely accepted that slower retractions are less traumatic [4, 18, 22], and recently published sternotomy retraction results using dummies and human cadavers have demonstrated that forces applied to hemisternum can reach 350 N (Aigner et al [23] and Saggio et al [24]). Bolotin et al [25–27], using a novel instrumented retractor, published measurements of forces during retraction in a sheep model and, importantly, demonstrated that force monitoring can reduce tissue trauma.…”

Section: Introductionmentioning

confidence: 99%

Retraction mechanics of Finochietto-style self-retaining thoracic retractors

et al. 2019

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Objectives Analyze the mechanics of Finochietto-style retractors, including the responses of thoracic tissues during thoracotomy, with an emphasis on tissue trauma and means for its reduction. Methods Mechanical analyses of the retractor were performed, including analysis of deformation under load and kinematics of the crank mechanism. Thoracotomies in a porcine model were performed in anesthetized animals (7) and fresh cadavers (17) using an instrumented retractor. Results Mechanical analyses revealed that arm motion is a non-linear function of handle rotation, that deformation of the retractor under load concentrates force at one edge of the retractor blade, and that the retractor behaves like a spring, deforming under the load of retraction and continuing to force open the incision long after crank rotation stops. Experimental thoracotomies included retractions ranging from 50 to 112 mm over 30 to 370 s, generating maximum forces of 118 to 470 N (12–50 kgf). Tissue ruptures occurred in 12 of the 24 retractions. These ruptures all occurred at retraction distances wider than 30 mm and at forces greater than 122.5 N. Significant tissue ruptures were observed for nearly all retractions at higher retraction rates (exceeding ½ rotation of the crank per 10 s). Conclusions The Finochietto-style retractor can generate large forces and some aspects of its design increase the probability of tissue trauma.

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“…Sternal wound healing still occurs in 0.4-7% of all cases (1,2). In order to prevent wound healing complications, mechanical forces on the sternum should be distributed evenly, while achieving optimal surgical sight for the performed procedure (3,4). Here, we present a novel sternal retractor offering a wide range of uses ranging from minimally invasive upper sternotomy approaches to full sternotomy during complex combined CABG and multi-valve procedures.…”

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confidence: 99%