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 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.

Superficial wound infection does not cause inferior clinical outcome after TKA

2016 ◽  
Vol 24 (10) ◽  
pp. 3088-3095 ◽  
Author(s):  
Pau Guirro ◽  
Pedro Hinarejos ◽  
Lluís Puig-Verdie ◽  
Juan Sánchez-Soler ◽  
Joan Leal-Blanquet ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Wound Infection ◽  
Superficial Wound Infection ◽  
Superficial Wound

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.

Comparative clinical efficacy of novel bidirectional cannula in cardiac surgery via peripheral cannulation for cardiopulmonary bypass

Perfusion ◽  
2021 ◽  
pp. 026765912110339
Author(s):  
Serdar Gunaydin ◽  
Seyhan Babaroglu ◽  
Ali Baran Budak ◽  
Bige Sayin ◽  
Velihan Cayhan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Adverse Events ◽  
Wound Infection ◽  
Doppler Ultrasonography ◽  
Secondary Outcome ◽  
Arterial Cannulation ◽  
Superficial Wound Infection ◽  
Superficial Wound ◽  
Distal Perfusion

Objectives: The aim of this study is to evaluate the safety and efficacy of the novel bidirectional cannula that ensures stable distal perfusion compared to conventional cannula in patients undergoing femoral arterial cannulation for cardiopulmonary bypass (CPB). Methods: During a 1-year period, 64 patients undergoing surgery via peripheral cannulation were prospectively randomized to receive 19 F bidirectional (Biflow™, LivaNova, Italy) or 19 F conventional (HLS Peripheral cannula, Getinge Group™, Germany) cannula with 6 F downstream line (Bicakcilar™, Turkey) for femoral artery cannulation. The primary outcome included the efficacy (adequacy of antegrade/retrograde comparative flow via cannula measured by doppler ultrasonography) and the secondary outcome was the safety (early/late complications and adverse events). Results: Percent flow (distal/proximal) after cannulation measured by doppler ultrasonography was significantly better in study group (33.1 ± 5 ml/min) versus downstream cannula (16.1 ± 4, p = 0.012). SpO2 measured by near infrared spectroscopy (NIRS) also demonstrated significantly better saturation in distal calf of the cannulated leg in bidirectional cannula group (67.5% ± 10% vs 52.5 ± 8, p = 0.04). The incidence of serious adverse events was seroma on femoral region (one patient), superficial wound infection (one patient), pseudo-hematoma (two patients) in bidirectional cannula group and in-hospital femoral embolectomy/artery repair (two patients), superficial wound infection (three patients), cannulation site hematoma (three patients) in conventional cannula group. Conclusions: This study demonstrates that in patients undergoing femoral arterial cannulation for CPB during cardiac surgery, the use of a novel bidirectional cannula is safe and easy to insert and provides stable distal perfusion of the cannulated limb.

scholarly journals Antibiotic-loaded bone cement combined with vacuum sealing drainage to treat deep sternal wound infection following cardiac surgery: the first case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xia Jiang ◽  
Fanyu Bu ◽  
Yong Xu ◽  
Zhaohui Jing ◽  
Guoqing Jiao ◽  
...  
Keyword(s):  
Case Report ◽  
Wound Infection ◽  
Bone Cement ◽  
Open Heart Surgery ◽  
Median Sternotomy ◽  
Stage I ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Vacuum Sealing ◽  
Vacuum Sealing Drainage

Abstract Background Deep sternal wound infection (DSWI) is a rare but serious complication after median sternotomy, and treatment success depends mainly on surgical experience. Here we first present a case of a patient successfully treated for antibiotic-loaded bone cement (ALBC) combined with vacuum sealing drainage (VSD) of DSWI. Case presentation This case report presented a patient who underwent open heart surgery, and suffered postoperatively from a DSWI associated with enterococcus cloacae. Focus debridement combined with ALBC filling and VSD was conducted in stage I. Appropriate antibiotics were started according to sensitivity to be continued for 2 weeks until the inflammatory markers decreased to normal. One month after the surgery, patient’s wound was almost healed and was discharged from hospital with a drainage tube. Two months after the stage I surgery procedure, the major step was removing the previous ALBC, and extensive debridement in stage II. The patient fully recovered without further surgical treatment. Conclusions The results of this case suggest that ALBC combined with VSD may be a viable and safe option for deep sternal wound reconstruction.

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