Reinforced Sternal Closure: The Bilateral Straight Longitudinal Wire Technique

2003 ◽  
Vol 11 (1) ◽  
pp. 90-91 ◽  
Author(s):  
Khalid Al Ebrahim
Keyword(s):  
Median Sternotomy ◽  
Sternal Dehiscence ◽  
Straight Wire ◽  
Sternal Closure

Sternal dehiscence and mediastinitis are among the most severe complications of median sternotomy. A simplified technique of reinforced closure is described. A straight wire is inserted longitudinally on each side of the sternum, placed within the transverse wires when the latter are approximated. Using this technique in 112 patients with a precarious sternum, no cases of sternal dehiscence or mediastinitis have been seen.

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.

A New Device for Securing Sternal Wires after Median Sternotomy

2018 ◽  
Vol 13 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Matthew R. Danter ◽  
Amy Saari ◽  
Min Gao ◽  
Anson Cheung ◽  
Samuel V. Lichtenstein ◽  
...  
Keyword(s):  
Biomechanical Testing ◽  
Median Sternotomy ◽  
Clinical Problem ◽  
Closure Device ◽  
Deep Sternal Wound Infection ◽  
Serious Adverse Events ◽  
Sternal Dehiscence ◽  
New Device ◽  
Sternal Closure ◽  
Group 2

Objective Morbidity due to sternotomy continues to be a significant clinical problem. Poor approximation of the sternum may lead to complications such as sternal dehiscence, infection, and pain. A device to assist in tensioning and twisting standard steel wires during sternal closure has been developed (TORQTM sternal closure device). Manually tightened interrupted wire closures were compared with those tightened and secured with the aid of the device. Performance of the device was assessed clinically. Methods Four cardiovascular surgeons performed manual and device-assisted closures on a biofidelic model. Closure force was measured to determine the residual force and its intraoperator variation. A retrospective review of patients treated before and after the introduction of the device was conducted. Predicted and actual outcomes were compared for the two groups (manual closure and deviceassisted closure). Results Biomechanical testing measured a 75% increase in residual closure force ( P < 0.001) and a significant reduction in the variability of the closure force ( P = 0.045) for device-assisted closures compared with manual closures. In the retrospective study, 3 of 173 manually closed patients had sterile sternal dehiscence and 1 of 173 had a deep sternal wound infection. In the device closure group, 2 of 127 had a sterile sternal dehiscence and no deep sternal wound infections were reported. No other device-related serious adverse events were reported. Conclusions Biomechanical data showed stronger, more consistent closure forces with the device. The retrospective data attest to the performance of the device.

scholarly journals OUTCOMES AND SAFETY OF STERNAL CLOSURE USING NON-ABSORBABLE POLYESTER BRAIDED SUTURE: SINGLE TERTIARY CARE CENTER EXPERIENCE OF 5 YEARS.

2020 ◽  
pp. 1-3
Author(s):  
Manpal Loona ◽  
Rahul Bhushan ◽  
Vaibhav chugh ◽  
Narender S. Jhajhria ◽  
Vijay Grover ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Care Center ◽  
Tertiary Care ◽  
Open Heart Surgery ◽  
Median Sternotomy ◽  
Wound Complications ◽  
Sternal Dehiscence ◽  
Sternal Closure ◽  
Surgical Suture ◽  
Poly Ethylene

Introduction: Median sternotomy is done as regular practice in cardiac surgery, which can lead to morbidity and mortality after sternal closure. Inappropriate sternal closure can lead to sternal dehiscence, sternal wound infection and mediastinitis. Aim: Efficacy and outcomes of sternal closure in adults weighing 2.5 kgs to 50 kgs using non-absorbable polyester braided suture. Methods: Total of 1091 patients underwent standard median sternotomy, weighing between 2.5 kgs to 50 kgs had sternal closure using non absorbable, braided, sterile, surgical suture composed of Poly ethylene terephthalate [polyester]. A retrospective analysis was done to review outcomes and complications related to this sternal closure technique. Results: Nineteen patients developed superficial surgical site infection and sternal sinus were seen in eight patients, whereas one patient had sternal dehiscence during immediate post-operative period. No sternal sutures were broken during the sternal closure and no case of mediastinitis was seen. Follow-up analyses of patients were done for 6 months after open heart surgery. Conclusion: Sternal closure using non-absorbable polyester braided suture is a safe and effective method with very less chances of post sternal wound complications in patients weighing between 2.5 kgs to 50 kgs.

scholarly journals Prakash versus figure of eight technique in sternal closure in CABG patients

2019 ◽  
Vol 6 (3) ◽  
pp. 828
Author(s):  
Mohammad M. Elsaify ◽  
Hatem M. Soltan ◽  
Rafik F. Soliman ◽  
Mohamed Gamal Hagag
Keyword(s):  
Median Sternotomy ◽  
Sternal Dehiscence ◽  
Sternal Closure ◽  
Group A ◽  
Patient Groups ◽  
Sternal Wound Infections ◽  
Group B ◽  
Cabg Patients ◽  
Suitable Technique

Background: Median sternotomy was recommended in 1957 by Julian for complete exposure of the heart. Despite the high importance of correct sternotomy, proper sternal closure is vital to ensure fewer post-operative complications. The sternum can be closed by wires and other methods. Sternal closure using the most suitable technique can dramatically reduce the risk of development of such complications.Methods: It is a prospective randomized comparative study of two patient groups, each included 30 patients, diagnosed of ischemic heart disease and underwent CABG. Group A with the patients’ sterna closed by figure of eight method and group B with multi-twist (Prakash) technique. Both groups were compared regarding postoperative pain and complications as superficial and deep sternal wound infections (SSWI, DSWI), wire removal and rewiring within six months of follow up.Results: The mean of minimum post sternotomy pain in group A patients was 24.50±11.7, whereas in patients of group B, it was 27±10.1. Only two patients (group A) suffered sternal dehiscence within six months follow up. The incidence of SSWI and DSWI among both groups was almost similar with only two patient of group A needed wire removal and one of them required rewiring.Conclusions: The multi-twist sternal closure provides better sternal stability after CABG especially in patients who are vulnerable to sternal dehiscence.

Selected Methods of the Chest Wall Reconstruction for Sternal Dehiscence after Median Sternotomy

2014 ◽  
Vol 86 (5) ◽  
Author(s):  
Edward Lewandowicz ◽  
Aleksandra Iljin ◽  
Anna Kasielska-Trojan ◽  
Marta Fijałkowska ◽  
Bogusław Antoszewski
Keyword(s):  
Chest Wall ◽  
Median Sternotomy ◽  
Chest Wall Reconstruction ◽  
Sternal Dehiscence

Resuture using Shirodkar tape for sternal dehiscence after extended thymectomy via median sternotomy

2009 ◽  
Vol 57 (6) ◽  
pp. 318-320
Author(s):  
Motoki Sakuraba ◽  
Hideaki Miyamoto ◽  
Shiaki Oh ◽  
Nobumasa Takahashi ◽  
Yoshikazu Miyasaka ◽  
...  
Keyword(s):  
Median Sternotomy ◽  
Extended Thymectomy ◽  
Sternal Dehiscence

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 Which Sternotomy Closure Method (Orthopaedic Wire or Suture) Is Recommended in Large Breed Dogs Undergoing a Median Sternotomy?

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Charlotte Howes ◽  
Guillaume Chanoit
Keyword(s):  
Open Access ◽  
Clinical Studies ◽  
Literature Search ◽  
Clinical Evidence ◽  
Median Sternotomy ◽  
Biomechanical Properties ◽  
Post Mortem ◽  
Bottom Line ◽  
Sternal Closure ◽  
Closure Method

<strong>PICO question</strong><br /><p>Which sternotomy closure method (orthopaedic wire or suture) is recommended in large breed dogs undergoing a median sternotomy?</p><strong>Clinical bottom line</strong><br /><p>The literature search revealed no clinical studies on large breed dogs comparing the clinical outcomes following either orthopaedic wire or suture sternotomy closure methods. Post-mortem studies on large breed dogs suggest that sutures are as suitable as orthopaedic wires for sternal closure with regards to their biomechanical properties. There is insufficient clinical evidence to make a recommendation that sutures be used in large breeds of dog.</p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" />

scholarly journals What is the impact of a previously failed Robicsek repair in the subsequent treatment of sternal dehiscence with thermoreactive nitinol clips?

2021 ◽  
Author(s):  
Yunus Seyrek ◽  
Murat Akkuş
Keyword(s):  
Treatment Group ◽  
High Risk ◽  
Complication Rate ◽  
Median Sternotomy ◽  
Sternal Dehiscence ◽  
High Risk Patients ◽  
Risk Patients ◽  
Group A ◽  
Group B ◽  
The Impact

Background: In this study, we conducted a retrospective review of patients at our institution with noninfectious sternal dehiscence (NISD) after median sternotomy who received thermoreactive nitinol clips (TRNC) treatment during a 10-year period. We compared TRNC patients with and without history of failed Robicsek repair. The purpose of the study was to analyze the impact of previous Robicsek repair on the treatment of sternal dehiscence with TRCN. Methods: Between December 2009 and January 2020, out of 283 patients with NISD who underwent refixation, we studied 34 cases who received TRNC treatment. We divided these 34 cases into two groups: patients who had a previously failed Robicsek procedure before TRNC treatment (group A, n=11) and patients who had been directly referred to TRCN treatment (group B, n= 23). Results: Postoperative complication rate was significantly higher in group A (p=0.026). Hospitalization duration was significantly longer in group A due to the higher complication rate (p=0.001). Operative time was significantly shorter and blood loss was significantly lower in group B (p=0.001). Conclusion: The Robicsek procedure is considered an effective method in the treatment of NISD but, in case of its failure, subsequent TRNC treatment might become cumbersome in high-risk patients. In our study, a previously failed Robicsek procedure caused significantly higher morbidity and additional operative risk in later TRNC treatment of high-risk cases. Ultimately, we speculate that a direct TRNC treatment for NISD is favorable in high-risk patients.

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