Influence of sternal closure technique on the incidence of sternal dehiscence and sternal wound infection

2009 ◽  
Vol 56 (S 01) ◽  
Author(s):  
C Schimmer ◽  
C Yildirim ◽  
K Hamouda ◽  
SP Sommer ◽  
M Bensch ◽  
...  
Keyword(s):  
Wound Infection ◽  
Sternal Wound Infection ◽  
Closure Technique ◽  
Sternal Dehiscence ◽  
Sternal Closure

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

2014 ◽  
Vol 5 (4) ◽  
Author(s):  
Aydın Tunçay ◽  
Yiğit Fevzi Akçalı ◽  
Rıfat Özmen ◽  
Özer Gazioğlu ◽  
Faruk Serhatlıoğlu
Keyword(s):  
Closure Device ◽  
Closure Technique ◽  
Sternal Dehiscence ◽  
Sternal Closure

scholarly journals Interlocking Multi-Twisted Wires Versus Interrupted Simple Sternal Wires for Closure of Median Sternotomy

2021 ◽  
Vol 24 (2) ◽  
pp. E363-E368
Author(s):  
Faisal Mourad ◽  
Ihab Ali
Keyword(s):  
Wound Infection ◽  
Open Heart Surgery ◽  
Median Sternotomy ◽  
Superficial Wound Infection ◽  
Sternal Dehiscence ◽  
Sternal Closure ◽  
Icu Stay ◽  
Group I ◽  
Superficial Wound ◽  
Length Of Icu Stay

Background: Although closure of a sternotomy incision is usually a simple procedure, failure to do so (sternal dehiscence) is a serious complication and is an independent factor that poses a high degree of morbidity or mortality after open heart surgery. Instability of the bone fragments can lead to complete sternal breakdown, sternal wound infection, and mediastinitis. The stainless-steel encircling wire used as either interrupted simple sutures or as figure of eight sutures is the current standard method of median sternotomy closure. Interlocking multi-twisted sternal wire closure is an alternative that provides rigid sternal fixation. We aim to identify the best method of sternal closure in order to implement it as a standardised protocol for our department. Methods: Two-hundred patients aged 18-70 years were undergoing cardiac surgeries at Ain Shams University hospitals. They were divided into two groups: Group I included 100 patients with sternal closure using simple wire, and group II included 100 patients with sternal closure using interlocking multi-twisted wires. The day 7, 1 month, and 3 months sternal instability, superficial wound infection, ventilation time, cross-clamp time, length of ICU stay, and length of hospital stay were analyzed. Results: The incidence of sternal instability on the 7th day, 1 month, and 3 months was significantly higher in the simple wire closure group (P < 0.05). However, incidence of superficial wound infection, length of ICU stay, and duration of mechanical ventilation were comparable between the two groups. Conclusion: The interlocking multi-twist is a safe, effective, and easily reproducible method for preventing sternal dehiscence.

scholarly journals Improved results of the vacuum assisted closure and Nitinol clips sternal closure after postoperative deep sternal wound infection

2009 ◽  
Vol 35 (5) ◽  
pp. 833-838 ◽  
Author(s):  
Maria Pia Tocco ◽  
Alberto Costantino ◽  
Milva Ballardini ◽  
Claudio D’Andrea ◽  
Marcello Masala ◽  
...  
Keyword(s):  
Wound Infection ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Vacuum Assisted Closure ◽  
Sternal Closure

607: INCIDENCE OF STERNAL WOUND INFECTION FOLLOWING DELAYED STERNAL CLOSURE: A PILOT STUDY

2018 ◽  
Vol 46 (1) ◽  
pp. 290-290
Author(s):  
Jaime Robenolt Gray ◽  
Julia Weiner ◽  
Stephen Saw ◽  
Gretchen Redline ◽  
Melanie Martinez ◽  
...  
Keyword(s):  
Pilot Study ◽  
Wound Infection ◽  
Sternal Wound Infection ◽  
Sternal Closure ◽  
Delayed Sternal Closure

Wire Cerclage Versus Cable Closure After Sternotomy for Dehiscence and DSWI: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 15 (4) ◽  
pp. 322-328
Author(s):  
Apurva Dixit ◽  
Derrick Y. Tam ◽  
Monica Yu ◽  
Bobby Yanagawa ◽  
Mario Gaudino ◽  
...  
Keyword(s):  
Systematic Review ◽  
Wound Infection ◽  
Meta Analysis ◽  
Median Sternotomy ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Sternal Dehiscence ◽  
Wire Cerclage ◽  
Lower Pain ◽  
Potential Alternative

Objective Cable closure has been introduced as a potential alternative to traditional wire cerclage (WC) for closure of median sternotomy. To evaluate whether cable closure improves patient outcomes, we conducted a systematic review and meta-analysis of the literature. Methods Ovid versions of Medline and Embase, and Google Scholar were used for the literature search. This yielded 7 studies ( n = 2,758), which compared traditional WC to cable closure systems. Outcomes included deep sternal wound infection, sternal dehiscence, postoperative pain score, and sternal wound infection. Results We found significantly lower incidence of sternal dehiscence for cable closure compared to WC (risk ratio [RR] 0.14, 95% confidence interval [CI]: 0.03 to 0.59 , P < 0.01 , I 2 = 0%) but no difference in DSWI (RR 0.97, 95% CI: 0.39 to 2.42, P = 0.95, I 2 = 33%). Cable closure was also associated with lower pain when compared with the WC group (mean difference −1.04 points, 95% CI: −1.89 to −0.19 , P = 0.02, I 2 = 87%). Conclusions This study suggests that cable closure results in less incidence of sternal dehiscence and pain compared to WC. Nonetheless, there remains a limited number of studies on this topic and further high-quality studies are required to confirm the results of this meta-analysis.

scholarly journals Initial Report of a New Suture Cerclage Tape for Sternal Closure

2021 ◽  
Author(s):  
Paul DiGiorgi
Keyword(s):  
Wound Infection ◽  
Bone Fractures ◽  
Steel Wire ◽  
Long Bone ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Initial Report ◽  
Sternal Closure ◽  
Measurable Amount ◽  
Wire Cerclage

PURPOSE: We sought to evaluate a new, flexible suture cerclage tape for sternal closure after cardiac surgery. DESCRIPTION: Fiber Tape (Arthrex, Naples, FL, USA) suture cerclage has been successfully utilized in the stabilization of long bone fractures. For sternal closure, it is placed similarly to wire cerclage. Uniquely, it allows a measurable amount of tension to be applied to the sternum and it is at least twice as strong as stainless steel wire. We hypothesized this new flexible tape would provide short term safety and efficacy, as measured by incidence of deep sternal wound infection. EVALUATION: We performed a retrospective, single center analysis of adult patients undergoing sternotomy closure with FT. The observed incidence of deep sternal wound infection (DSWI) was compared to the expected incidence calculated through the Society of Thoracic Surgery (STS) risk calculator. A total of 45 patients were closed with FT. No patients suffered DSWI. Thirty of the 45 patients had STS risk calculations. For these 30 patients, the expected rate of DSWI was 0.2%. CONCLUSIONS: Despite study limitations, FT appears to be a safe method for sternal closure.

Pilot Study of Sternal Plating for Primary Closure of the Sternum in Cardiac Surgical Patients

2011 ◽  
Vol 6 (6) ◽  
pp. 382-388 ◽  
Author(s):  
Elliott Bennett-Guerrero ◽  
Barbara Phillips-Bute ◽  
Peter M. Waweru ◽  
Jeffrey G Gaca ◽  
James C. Spann ◽  
...  
Keyword(s):  
Pilot Study ◽  
Wound Infection ◽  
Primary Endpoint ◽  
Postoperative Recovery ◽  
Surgical Patients ◽  
Wound Complications ◽  
Rigid Fixation ◽  
Sternal Wound Infection ◽  
Sternal Closure ◽  
Incentive Spirometry

Objective Postoperative sternal wound complications are a significant problem in high-risk patients. In addition to closure with conventional wires, several systems involving rigid fixation with metal plates are currently available. The Rapid Sternal Closure System (Talon) is approved for stabilization and fixation of the anterior chest wall. Anecdotal evidence suggests that use of the Talon may result in improved postoperative recovery. Methods Fifty-one cardiac surgical patients at higher risk for sternal wound complications were enrolled at two sites. Subjects were randomized to insertion of Talons (n = 28) or wires only (control, n = 23) for sternal closure. The primary endpoint was a comparison between study groups of the percent of baseline incentive spirometry volume through postoperative day 7. Secondary endpoints included other measures of quality of recovery, sternal wound infection, and nonunion. Results The percentage of preoperative incentive spirometry volume achieved was higher in the Talon arm (67% ± 32%) versus control (58% ± 24%); however, this was not statistically significant (P = 0.41). Use of the Talon was associated with decreased use of opiates (21.3 ± 11.8 vs 25.4 ± 21.6 mg, P = 0.44), increased ability to ambulate 1000 ft on postoperative day 5 (25% vs 13%, P = 0.28), and decreased duration of mechanical ventilation (median 0.5 vs 1.0 days, P = 0.24) and hospital length of stay (4.5 ± 3.2 vs 5.3 ± 4.0 days, P = 0.40). One superficial sternal wound infection was observed in each study arm. There were no cases of nonunion. Conclusions In this pilot study, the primary endpoint was not statistically different between the treatment groups. Use of the Talon was associated with trends toward benefit in endpoints consistent with enhanced postoperative recovery, highlighting a need for additional data from larger randomized trials.

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