Sternal Instability After Midline Sternotomy

Robicsek, Francis; Fokin, Alex; Cook, Joseph W.; Bhatia, Deepak N.

doi:10.1055/s-2000-9945

Cited by 155 publications

(171 citation statements)

References 26 publications

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“…There is a general consensus that bone wax may affect the consolidation of the sternum [5], which is particularly important in patients at high risk for sternal complications, such as elderly, obese, diabetic, pulmonary disease, chronic renal failure and patients on corticosteroid therapy [6 -13]. The sternal dehiscence can significantly prolong the hospital stay and become a lethal complication.…”

Section: Discussionmentioning

confidence: 99%

Geli Putty<sup>®</sup>

Volpe¹,

Martinez²

2011

Rev Bras Cir Cardiovasc

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Section: Discussionmentioning

confidence: 99%

Geli Putty<sup>®</sup>

Volpe¹,

Martinez²

2011

Rev Bras Cir Cardiovasc

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“…Previously reported preoperative risk factors for SD are obesity [2][3][4][5][6][7][8], Diabetes mellitus (DM) [9], chronic obstructive pulmoner disease (COPD) [2][3][4][5][6][7][8][9], chronic cough [10], smoking [2,3], New York Heart Association (NYHA) functional class [11] , osteoporosis [1,2], use of acetylcholinesterase (ACE) inhibitors [10],use of ß-adrenergic drugs for respiratory problems [11], immunosuppression [2][3][4][5][6][7][8][9], and previous sternotomy [9] . Operative risk factors are bilateral internal mammary artery (IMA) harvest [9], excessive amounts of blood transfusion [11], off-midline sternotomy [12], and prolonged cardiopulmonary bypass (CPB) time [3].…”

Section: Introductionmentioning

confidence: 99%

“…Sternal motion and instability may occur in the first days or weeks after MS owing to technical issues with the bone, wire, or surgical technique. This may resolve and heal normally, or it may lead to dehiscence because of fracture of the sternal bone or the sternal wires [2]. SD with or without infection can occur in 0.2% to 5% of patients as a result of primary nonunion, poor wound healing, or premature overexertion [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Vitalitec International, The Sternal Closure Device: A novel closure technique for sternal dehiscence

Tunçay

Akçalı²,

Özmen³

et al. 2014

J Clin Exp Invest

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Objective: Impaired sternal wound healing remains problematic after median sternotomy and can cause to significant morbidity after cardiac surgical procedures. Although some reconstruction systems exist for sternal closure, their use is limited by expense and practicality, and simple wire closure remains the most common technique to close the sternum. In this study, we aim to discuss the results of 6 cases that underwent surgery for sternal dehiscence(SD). Methods:We reviewed six patients with sternal dehiscence who underwent surgery in our department between April 2013 and May 2014. We have used a novel closure technique in six patients with sternal dehiscence and evaluated early-term results of sternal clips plus rewiring following failed sternal closure. Results:The mean age was 63 (range, 55 to 79 years). All patients were male. We have used a novel closure technique with sternal clips plus rewiring in all patients. We evaluated six patients with non-infectious SD. Sternal reconstruction using rigid fixation with clips improve bone healing and reduce early postoperative pain. All cases were discharged with successful treatment. Conclusions:We believe that this method of sternal closure guarantees better clinical outcomes rather than sternal wire closure. Additionally, SCD(sternal closure device) clips proved to be cost effective in cardiac surgery. J Clin Exp Invest 2014; 5 (4): 534-538Key words: Sternal dehiscence, closure technique, cardiac surgery ÖZET Amaç: Median sternotomi sonrası bozulmuş sternal yara iyileşmesi kardiak cerrahi sonrası önemli morbidite sebebi olabilir. Sternum kapatılması için bazı teknikler mevcut olmasına rağmen pratikte sınırlıdır ve sternumu basit tel tekniği ile kapatma uygulanan en yaygın tekniktir. Bu çalışmada sternal ayrılma nedeniyle cerrahi uygulanan 6 olgunun sonuçlarını tartışmayı hedefliyoruz. Sonuç: Sternumun bu yöntem ile kapatılmasının tel ile kapatılmasına göre daha etkin ve daha iyi klinik sonuçlar verdiğine inanıyoruz, ayrıca kalp cerrahisinde sternal kapama klipslerin kullanılması daha düşük maliyetli olduğu görülmüştür.

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“…Sternal dehiscence can be non-infectious (biomechanical failure occurring in 0.2-5%) or infectious (deep sternal wound infection-DSWI in 0.3-5%) [1][2][3]. Biomechanical failure is usually due to sternal wire cut-through [4]; that is, sterile dehiscence; whereas DSWI is associated with the signs and symptoms of an infected surgical site.…”

Section: Introductionmentioning

confidence: 99%

“…Sternal wound complications are associated with intensive medical therapy, prolonged in-hospital stay and a high mortality rate [6]. The multitude of independent risk factors influencing the incidence of DSWI implies the complexity of the pathology [1,2,[7][8][9]. Prevention of DSWI should be focused on achieving mechanical sternal stability and preventing infection.…”

Section: Introductionmentioning

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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Sternal Instability After Midline Sternotomy

Cited by 155 publications

References 26 publications

Geli Putty<sup>®</sup>

Geli Putty<sup>®</sup>

Vitalitec International, The Sternal Closure Device: A novel closure technique for sternal dehiscence

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

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