Multidisciplinary Surgery In Thoracic Wall Reconstruction For Sternal Osteomyelitis

Sternal osteomyelitis and dehisense are a common problem with an incidence rate of 0.5% to 5.0% after major cardiac surgery. However, the management of separation of the sternum in the patient’s thorax remains a challenge for cardiac surgeons and thoracic surgeons using the incision. After cardiac surgery, postop sternal dehiscence and osteomyelitis was developed in the patient. The old steel wires were removed and the sternum was resected due to long-term infection and extensive deformation of the sternum. Pectoralis muscle flaps were partially mobilized and adducted. The large defect was closed using a large prolene patch. Proper sized transversal titanium plates were selected. Due to the sternum bone was severely destroyed by infection, longer transversal titanium plates were chosen to achieve thoracic stability. Healthy tissues were detected on the ribs. A total of 4 titanium plates were placed intermittently. The plates were fixed to the ribs with titanium locking screws. The pectoral muscle flaps adducted to the plates by the plastic surgery team. A total of 3 drains were placed, one in the mediastinum and two between the thoracic wall and muscle structures.

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Multidisciplinary Surgery in Thoracic Wall Reconstruction for Sternal Osteomyelitis

Clinics in Surgery ◽

10.25107/cis-v6-id3075 ◽

2016 ◽

Vol 6 (1) ◽

pp. 1-3

Author(s):

Anil Gokce ◽

Seyhan Babaroglu ◽

Hasan Murat Ergani ◽

Yucel Akkas

Keyword(s):

Cardiac Surgery ◽

Pectoral Muscle ◽

Thoracic Wall ◽

Large Defect ◽

Muscle Flaps ◽

Sternal Osteomyelitis ◽

Thoracic Wall Reconstruction ◽

Cardiac Surgeons ◽

Extensive Deformation

Sternal osteomyelitis and dehiscence are a common problem with an incidence rate of 0.5% to 5.0% after major cardiac surgery. However, the management of separation of the sternum in the patient's thorax remains a challenge for cardiac surgeons and thoracic surgeons using the incision. After cardiac surgery, post-op sternal dehiscence and osteomyelitis was developed in the patient. The old steel wires were removed and the sternum was resected due to long-term infection and extensive deformation of the sternum. Pectoralis muscle flaps were partially mobilized and adducted. The large defect was closed using a large prolene patch. Proper sized transversal titanium plates were selected. Due to the sternum bone was severely destroyed by infection, longer transversal titanium plates were chosen to achieve thoracic stability. Healthy tissues were detected on the ribs. A total of 4 titanium plates were placed intermittently. The plates were fixed to the ribs with titanium locking screws. The pectoral muscle flaps adducted to the plates by the plastic surgery team. A total of 3 drains were placed, one in the mediastinum and two between the thoracic wall and muscle structures.

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Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease – the perspective of cardiac surgery

Cardiology in the Young ◽

10.1017/s1047951108002813 ◽

2008 ◽

Vol 18 (S2) ◽

pp. 101-115 ◽

Cited By ~ 35

Author(s):

Marshall Lewis Jacobs ◽

Jeffrey Phillip Jacobs ◽

Rodney C.G. Franklin ◽

Constantine Mavroudis ◽

Francois Lacour-Gayet ◽

...

Keyword(s):

Cardiac Surgery ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

The United Kingdom ◽

Current State ◽

Long Term Follow Up ◽

History Of ◽

Cardiac Surgeons

AbstractThis review includes a brief discussion, from the perspective of cardiac surgeons, of the rationale for creation and maintenance of multi-institutional databases of outcomes of congenital heart surgery, together with a history of the evolution of such databases, a description of the current state of the art, and a discussion of areas for improvement and future expansion of the concept. Five fundamental areas are reviewed: nomenclature, mechanism of data collection and storage, mechanisms for the evaluation and comparison of the complexity of operations and stratification of risk, mechanisms to ensure the completeness and accuracy of the data, and mechanisms for expansion of the current capabilities of databases to include comparison and sharing of data between medical subspecialties. This review briefly describes several European and North American initiatives related to databases for pediatric and congenital cardiac surgery the Congenital Database of The European Association for Cardio-Thoracic Surgery, the Congenital Database of The Society of Thoracic Surgeons, the Pediatric Cardiac Care Consortium, and the Central Cardiac Audit Database in the United Kingdom. Potential means of approaching the ultimate goal of acquisition of long-term follow-up data, and input of this data over the life of the patient, are also considered.

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Evaluation of Stress Levels of Trainee Cardiac Surgery Residents during Training Interventions Using Physiological Stress Parameters

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182211953 ◽

2021 ◽

Vol 18 (22) ◽

pp. 11953

Author(s):

George Awad ◽

Robert Pohl ◽

Sabine Darius ◽

Beatrice Thielmann ◽

Boris Kuzmin ◽

...

Keyword(s):

Cardiac Surgery ◽

Stress Responses ◽

Physiological Stress ◽

Stress Index ◽

Surgical Interventions ◽

Training Interventions ◽

Stress Levels ◽

Surgical Teaching ◽

Cardiac Surgeons

Background: This study analysed the psychological and psycho-emotional stress in cardiac surgery. Using heart rate variability (HRV) analysis, it is possible to record intraoperative objective stress responses in surgeons. The aim of the study was to assess with the help of HRV parameters the postulated increased stress levels of cardiac surgeons in training compared to experienced senior cardiothoracic surgeons in exactly the same work situation in order to make qualification-differentiated statements about physiological stress during surgical interventions. Methods: During surgical teaching procedures, long-term ECG data (n = 15 each) for two operating residents and their assisting senior physicians were recorded. Time and frequency domain HRV parameters were analysed. Results: The time-related parasympathetic-dominated HRV parameters RMSSD (19.5 ms vs. 28.1 ms), NN50 (297.67 vs. 693.40), and cardiac interval mean RR (692.8 ms vs. 737.3 ms) indicate a higher stress level in the operating residents compared to the experienced surgeons. The higher stress index (11.61 vs. 8.86) confirms this. Conclusion: Compared to experienced surgeons, operating residents showed lower parasympathetic activity and higher stress levels during cardiac surgery training procedures.

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