Sternal salvage with rigid fixation in the setting of a massive mediastinal aortic pseudoaneurysm: a case report and review of the literature

Shifrin, David A.; Sohn, Samuel M.; Stouffer, Chadwick W.; Hooker, Robert L.; Renucci, John D.

doi:10.1016/j.bjps.2007.09.022

Cited by 3 publications

(5 citation statements)

References 11 publications

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“…Studies 18,48 have indicated the advantages of the wiring techniques over plating systems due to their practicality and cost-effectiveness. However, other studies 9,25,56,58,59,86 contradicted the advantageous use of conventional wiring techniques and elucidated the impact of plating in reducing post-operative complications. Cohen and Griffin 9 and Ozaki et al., 86 for example, demonstrated that the H-shaped system is preferred over wiring by providing more stability, less disruption to the underlying vasculature, decreased chance of infection and less pain; nevertheless, further research is required for robust sternal fixation in cases such as osteoporotic patients and those suffering from DSWI.…”

Section: Discussionmentioning

confidence: 99%

“…Shifrin et al. 59 applied a sternal-lock (Lorenze) plate fixation to a 58-year-old man who had a pulsatile, enlarging mediastinal mass (16 × 14 × 14 cm) following a massive aortic pseudoaneurysm surgical operation (Figure 5). Thoracic surgery aimed to reconstruct the aortic arch and involved direct approximation of the sternal edges using forceps.…”

Section: Sternal Fixationsmentioning

confidence: 99%

“…

Figure 5.CT scan for the massive aortic pseudoaneurysm for a 58-year-old man. 59 Source: reproduced with permission from Elsevier, 2013. CT: computerized tomography. …”

Section: Sternal Fixationsmentioning

confidence: 99%

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A review of sternal closure techniques

Alhalawani

Towler

2013

J Biomater Appl

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Sternotomy and sternal closure occur prior to and post cardiac surgery, respectively. Although post-operative complications associated with poor sternal fixation can result in morbidity, mortality, and considerable resource utilization, sternotomy is preferred over other methods such as lateral thoracotomy. Rigid sternal fixation is associated with stability and reduced incidence of post-operative complications. This is a comprehensive review of the literature evaluating in vivo, in vitro, and clinical responses to applying commercial and experimental surgical tools for sternal fixation after median sternotomy. Wiring, interlocking, plate-screw, and cementation techniques have been examined for closure, but none have experienced widespread adoption. Although all techniques have their advantages, serious post-operative complications were associated with the use of wiring and/or plating techniques in high-risk patients. A fraction of studies have analyzed the use of sternal interlocking systems and only a single study analyzed the effect of using kryptonite cement with wires. Plating and interlocking techniques are superior to wiring in terms of stability and reduced rate of post-operative complications; however, further clinical studies and long-term follow-up are required. The ideal sternal closure should ensure stability, reduced rate of post-operative complications, and a short hospitalization period, alongside cost-effectiveness.

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Section: Discussionmentioning

confidence: 99%

Section: Sternal Fixationsmentioning

confidence: 99%

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A review of sternal closure techniques

Alhalawani

Towler

2013

J Biomater Appl

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“…The device was then placed and locked by screwing into the sternum. Shifrin et al [79] applied a sternal-lock (Lorenze) plate fixation to a 58 year old man who had a pulsatile, enlarging mediastinal mass (16x14x14 cm) following a massive aortic pseudoaneurysm surgical operation (Figure 1.12). Thoracic surgery aimed to reconstruct the aortic arch, and involved direct approximation of the sternal edges using forceps.…”

Section: Plate-screw Systemsmentioning

confidence: 99%

“…Figure1.12: Computerized tomography scan for the massive aortic pseudoaneurysm for a year old man[79] …”

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Design & development of a novel glass polyalkenoate cement for sternal fixation and repair, in the event of median sternotomy surgery

Alhalawani¹

2021

Preprint

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Median sternotomy surgery is the gold standard for cardiac/thoracic procedures such as open-heart surgery. With over one million median sternotomy surgeries performed worldwide every year, sternal wound complications pose a serious risk to the health of affected patients. Various techniques have been used for sternal fixation including wiring, plate-screw systems and cementing. The ideal sternal closure device is the one which has mechanical properties suited to the local environment, biocompatibility, radio-opacity, cost-effectiveness and ease of removal when necessary. None of the techniques that have been utilized for sternal fixation to date address all of these requirements. Glass polyalkenoate cements (GPCs) have a long history of use in restorative and orthodontic dentistry and ear, nose and throat (ENT) surgery but have yet to be indicated for musculoskeletal applications. This dissertation relates to the development of new GPC-based adhesives for use in sternal closure. A series of novel glasses based on the system 48SiO2-(36-X) ZnO-6CaO-8SrO-2P2O5-XTa2O5 with X varying from 0.0 to 8.0 mole percentage were fabricated and characterized. The structural features as a function of Ta2O5 content were investigated by network connectivity (NC) calculations, x-ray diffraction (XRD), particle size analysis (PSA), scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS), x-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FTIR) and magic angle spinning-nuclear magnetic resonance (MAS-NMR). The thermal properties of the glasses were obtained by performing simultaneous thermal analysis (STA). The effect of glass structure on pH and solubility was also evaluated. The formulated glasses were used to prepare GPC adhesive materials and tested for their suitability for sternal fixation. The data collected has confirmed that substituting up to 0.5 mole percentage of ZnO with Ta2O5 in the glass system under study resulted in the formation of adhesives that are deemed suitable for sternal fixation. The formulated cements, based on the use of glasses containing no greater than 0.5 mole percentage of Ta2O5 have rheology, strength, radiopacity, antibacterial and in-vitro behavior suitable for sternal fixation. To the best knowledge of the candidate, this dissertation is the first to report the use of tantalum-containing GPC-based adhesives for sternal closure. Based on the obtained results, the formulated adhesives can be used in conjunction with sternal cable ties (current standard method) to offer optimal fixation for patients and reduce post-operative complications such as bacterial infection and pain from micro-motion.

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