scholarly journals Commentary: Sternal Wound Complications and Internal Mammary Harvesting Technique: An Unresolved Debate

2021 ◽  
Author(s):  
Sameer A. Hirji ◽  
Hiba Ghandour ◽  
George Tolis
Keyword(s):  
Wound Complications ◽  
Harvesting Technique ◽  
Internal Mammary

scholarly journals Total arterial myocardial revascularization using bilateral internal mammary arteries and the role of postoperative sternal stabilization to reduce wound infections in a large cohort study

2019 ◽  
Vol 29 (2) ◽  
pp. 224-229 ◽  
Author(s):  
Marc Albert ◽  
Ragi Nagib ◽  
Adrian Ursulescu ◽  
Ulrich F W Franke
Keyword(s):  
Retrospective Study ◽  
Wound Infection ◽  
Internal Mammary Artery ◽  
Wound Closure ◽  
Myocardial Revascularization ◽  
Wound Complications ◽  
Wound Infections ◽  
Term Survival ◽  
Mammary Arteries ◽  
Internal Mammary

Abstract OBJECTIVES Total arterial myocardial revascularization using bilateral internal mammary arteries shows improved results for mortality, long-term survival and superior graft patency. It has become the standard technique according to recent guidelines. However, these patients may have an increased risk of developing sternal wound infections, especially obese patients or those with diabetes. One reason for the wound complications may be early sternum instability. This situation could be avoided by using a thorax support vest (e.g. Posthorax® vest). This retrospective study compared the wound complications after bilateral internal mammary artery grafting including the use of a Posthorax vest. METHODS Between April 2015 and May 2017, 1613 patients received total arterial myocardial revascularization using bilateral internal mammary artery via a median sternotomy. The Posthorax support vest was used from the second postoperative day. We compared those patients with 1667 patients operated on via the same access in the preceding 26 months. The end points were the incidence of wound infections, when the wound infection occurred and how many wound revisions were needed until wound closure. RESULTS The demographic data of both groups were similar. A significant advantage for the use of a thorax support vest could be seen regarding the incidence of wound infections (P = 0.036) and the length of hospital stay when a wound complication did occur (P = 0.018). CONCLUSIONS As seen in this retrospective study, the early perioperative use of a thorax stabilization vest, such as the Posthorax vest, can reduce the incidence of sternal wound complications significantly. Furthermore, when a wound infection occurred, and the patient returned to the hospital for wound revision, patients who were given the Posthorax vest postoperatively had a significantly shorter length of stay until wound closure.

Wound complications and 30‐day readmissions after single and bilateral internal mammary grafting: Analysis of the Nationwide Readmissions Database

2020 ◽  
Vol 36 (1) ◽  
pp. 74-81
Author(s):  
Sameer Hirji ◽  
Rohan Shah ◽  
Shawn Shah ◽  
Alexis Okoh ◽  
Laura Seese ◽  
...  
Keyword(s):  
Wound Complications ◽  
Internal Mammary

174 Semi-Skeletonized Versus Pedicled Internal Mammary Artery Harvesting: A Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A M A Shafi ◽  
S Mellor ◽  
S Iddawela ◽  
L Brown ◽  
A Harky
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Preparation Technique ◽  
Operative Outcomes ◽  
Harvesting Technique ◽  
Internal Mammary

Abstract Objectives To compare semi-skeletonized with pedicled harvesting technique of the internal mammary artery for coronary artery bypass surgery. Method A comprehensive literature search was performed on PubMed, Cochrane database, Embase, Google Scholar and Ovid identifying articles that compared semi-skeletonised to pedicled internal mammary artery in the use of coronary artery bypass surgery. Databases were evaluated and assessed from inception to July 2020. Results Only five studies fulfilled the criteria for this review. There was no reported incidence of sternal wound infection, myocardial infarction, or mortality. The length of the IMA graft was longer in the semi-skeletonized group compared to the pedicled group, 16.06cm versus 14.63cm respectively (p < 0.001). The intraoperative diastolic flow was significantly greater in the semi-skeletonized grafts than in the pedicled grafts during (p = 0.003) and after (p = 0.005) cardiopulmonary bypass. The incidence of pleural effusion (pedicled, 52.6%; semi-skeletonized, 23.6%; p = 0.002) and atelectasis (pedicled, 42.1%; semi-skeletonized, 20.0%, p = 0.015) were significantly higher in pedicled group. Post-operative chest tube drainage was significantly higher in the pedicled group (608 ± 58 mL compared to 470 ± 48 mL; p = 0.027). Additionally, FEV1 was significantly decreased in the pedicled group 6 days after surgery (pedicled:76.0% ± 1.6%; semi-skeletonized: 83.2% ± 1.6%; p = 0.020). Conclusions These results demonstrate that the semi-skeletonized preparation technique is associated with satisfactory outcomes during harvesting the internal mammary artery. Yet, due to limited numbers of studies, there is need for larger comparative studies to assess post-operative outcomes with a longer period of follow up.

Modified internal mammary artery perforator flap in treatment of sternal wound complications

2018 ◽  
Vol 52 (5) ◽  
pp. 275-280
Author(s):  
Heidi-Mari P. Myllykangas ◽  
Paula K. Mustonen ◽  
Jari K. Halonen ◽  
Leena T. Berg
Keyword(s):  
Internal Mammary Artery ◽  
Perforator Flap ◽  
Wound Complications ◽  
Internal Mammary ◽  
Artery Perforator

Use of the No-Touch Saphenous Vein Harvesting Technique via Small Incisions

2019 ◽  
Vol 15 (1) ◽  
pp. 81-84
Author(s):  
Ichiro Hayashi ◽  
Ichiro Kashima ◽  
Eiji Yoshikawa
Keyword(s):  
Saphenous Vein ◽  
Vasa Vasorum ◽  
Surrounding Tissue ◽  
Wound Complications ◽  
Main Trunk ◽  
Vessel Sealing ◽  
Harvesting Technique ◽  
Sealing Device ◽  
Bipolar Vessel Sealing ◽  
Bipolar Vessel

There are substantial data in support of improved patency using the no-touch (NT) saphenous vein (SV) harvesting technique. However, wound complications correlated with such are more significant than those associated with the skeletonized technique. To solve this, we introduced the use of the electrothermal bipolar vessel sealing device via small incisions. In this study, a cordless retractor with a built-in LED light source was utilized. The NT-SV graft was harvested with a pedicle of surrounding tissue approximately 5 mm in size and attached to the main trunk. The intima, tunica media, adventitia, and vasa vasorum appeared normal by histological analysis. Our technique combines the potential advantages of a minimally invasive endoscope approach using bipolar electrothermy and the improved patency of a NT-SV.

Early Results with Bilateral and Single Internal Mammary Artery Grafts. Are They Different?

1997 ◽  
Vol 5 (1) ◽  
pp. 8-14
Author(s):  
Naresh Trehan ◽  
Surendra Nath Khanna ◽  
Vijay Mohan Kohli ◽  
Anil Karlekar ◽  
Yugal Mishra ◽  
...  
Keyword(s):  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Perioperative Complications ◽  
Myocardial Revascularization ◽  
Wound Complications ◽  
Vein Grafts ◽  
Early Results ◽  
Total Hospital Stay ◽  
Internal Mammary

Between June 1991 and June 1996, 391 patients underwent isolated myocardial revascularization using bilateral internal mammary artery. Three hundred and sixty-five of these patients could be matched retrospectively on the basis of preoperative characteristics with 365 patients operated on during same period who had left internal mammary artery as a single or sequential graft with additional vein grafts. The cardiopulmonary bypass times and aortic cross-clamp times were similar in both groups. There were no statistically significant differences in the two groups in terms of operative mortality (0.55% versus 0.82%), perioperative myocardial infarction (2.46% versus 2.19%), low cardiac output (1.64% versus 1.09%), reexplorations (1.10% versus 1.92%), wound complications (1.10% versus 2.46%), length of stay in the intensive care unit, and total hospital stay. The incidence of respiratory, central nervous system, and renal complications showed no difference between the two groups. Logistic regression analysis showed that the number of internal mammary artery grafts was not a predictor for perioperative complications. If better long-term event-free survival is associated with the use of bilateral internal mammary artery, it should be used wherever possible.

No-Touch Sequential Saphenous Venous Harvesting Technique in Off-Pump Bypass Surgery: A Retrospective Study

2021 ◽  
Author(s):  
Xuejian Hou ◽  
Kui Zhang ◽  
Taoshuai Liu ◽  
Yang Li ◽  
Yang Zhao ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
Conventional Technique ◽  
Wound Complications ◽  
Off Pump ◽  
Vein Grafts ◽  
Harvesting Technique ◽  
Significant Difference ◽  
Pump Cabg

Abstract Background In the mid-1990s, the Swedish expert team proposed saphenous vein graft (SVG) harvesting with pedicle tissue. The short-term and long-term patency rates of the great saphenous vein obtained by the no-touch technique (NT) were higher than those obtained by the conventional technique (CON). In the past, NT technology was mainly used in on-pump coronary artery bypass grafting (CABG), and vein grafts were mostly single vein grafts. In this study, we retrospectively analysed the safety and effectiveness of sequential vein grafts using NT technology in off-pump CABG. Methods From 2017 to 2019, a total of 505 patients were included in the study. There were 150 patients in the NT group and 355 patients in the CON group. After applying propensity score matching (1:1 matching), 148 patients were included in each group. Baseline data, graft patency, postoperative complications, leg wound complications and 1-year major adverse cardiac and cerebrovascular events (MACCEs) were compared between the two groups. Results There was no significant difference in the patency rate of sequential venous grafts between the two groups one year after the operation either before (NT: 7.1% (10/141) vs CON: 11.5% (38/331), p = 0.149) or after matching (NT: 7.1% (10/140) vs CON: 7.3% (9/124), p = 0.971). There was no significant difference in the composite clinical endpoint between the two groups either before (NT: 3 (2.3%) vs CON: 9 (2.8%), p = 1.000) or after matching (NT: 3 (2.3%) vs CON: 3 (2.5%), p = 1.000). There were differences in leg wound complications between the two groups both before (NT: 9 (6.9%) vs CON: 6 (1.9%), p = 0.007) and after matching (NT: 9 (6.9%) vs CON: 2 (1.7%), p = 0.043). Conclusions The application of the NT technique in off-pump CABG with sequential vein grafts is safe and effective. Leg wound complications are more common with the NT technique than with the conventional technique.

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