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

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.

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Efficacy of Thermoreactive Nitinol Clip Implantation in Reconstruction of Sternal Dehiscence

The Heart Surgery Forum ◽

10.1532/hsf98.20121056 ◽

2012 ◽

Vol 15 (5) ◽

pp. 280 ◽

Cited By ~ 3

Author(s):

Adem Guler ◽

Ahmet Baris Durukan ◽

Hasan Alper Gurbuz ◽

Murat Tavlasoglu ◽

Mehmet Ali Sahin ◽

...

Keyword(s):

Heart Surgery ◽

Open Heart Surgery ◽

Median Sternotomy ◽

Easy Method ◽

Sternal Dehiscence ◽

Medical Centers ◽

Sternal Reconstruction ◽

The Mean

Background: Sternal dehiscence is a severe complication of open heart surgery. Reinforced wiring, a system of reinforced sternal closure, fixation of a rigid plate, and implantation of thermoreactive nitinol clips (TRC) are some surgical procedures used. The aim of this study was to evaluate the role of TRC for secondary sternal reconstruction.Methods: Of 1198 patients who underwent their operations via median sternotomy in 2 separate medical centers, sternal dehiscence was observed in 16 patients overall (1.33%). The mean (SD) age of the patients was 64.06 � 9.18 years (range, 40-77 years). Sternal dehiscence was diagnosed in all patients between the fifth and 30th postoperative days.Results: TRC were implanted in all of the patients who developed sternal dehiscence (16 patients). One patient developed severe respiratory failure, became ventilator dependent, and died from pneumonia on postoperative day 24. The other 15 patients were discharged without complications. Postoperative follow-up of the surviving patients revealed adequate and satisfactory sternal stability.Conclusion: Implantation of TRC is an effective and easy method for fixing the sternum and can be performed rapidly and securely.

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Retrospective Analysis of Flap Based Management in Deep Sternal Wound Infection in a Tertiary Care Centre –A Single Centre Study

PERSPECTIVES IN MEDICAL RESEARCH - 2 ◽

10.47799/pimr.0902.15 ◽

2021 ◽

Vol 9 (2) ◽

pp. 69-72

Author(s):

Sartaj Guroo ◽

Ajit Padhy ◽

Khushwant Popli ◽

Ridhika Munja ◽

Navnita Kisko ◽

...

Keyword(s):

Wound Infection ◽

Heart Surgery ◽

Tertiary Care ◽

Open Heart Surgery ◽

Median Sternotomy ◽

Muscle Flap ◽

Deep Sternal Wound Infection ◽

Sternal Wound Infection ◽

Flap Surgery ◽

Fascial Flap

Aims: In this retrospective study we analyzed the outcomes of flap based management in deep sternal wound infection (DSWI). Materials & Methods: Patients, who had undergone open heart surgery through median sternotomy between September 2017 and March 2020 and had developed deep sternal infections, were retrospectively analyzed in this study. Few patients found to have DSWI were managed only by Negative Pressure Wound Therapy (NPWT) and few were managed by NPWT and Bipectoral musculo fascial flap cover. The outcomes in terms of mortality and readmission in the postoperative course were obtained from the records during subsequent follow ups in OPD for six months. Results: Out of 925 patients 11 patients (1.2%) had deep sternal wound infection There were six patients (n=6, 54.55%) who received NPWT where as five patients (n=5, 45.45 %) received flap surgery following NPWT. The patient who underwent Flap surgery had a longer postoperative stay than NPWT group (46.2+/- 22.21, C.I 95%) days Vs (25.5+/- 14.41, C.I 95%) days. However, the readmission due to recurrence of infection was seen only in NPWT group (n=3, 50%) with in the period of six months following discharge. One patient out of the three readmitted patients expired due to sepsis. Conclusion: NPWT followed by bipectoral muscle flap closure has a better surgical outcome than NPW alone in deep sternal wound infection in early postoperative period

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Design & development of a novel glass polyalkenoate cement for sternal fixation and repair, in the event of median sternotomy surgery

10.32920/ryerson.14648061 ◽

2021 ◽

Author(s):

Adel M.F. Alhalawani

Keyword(s):

Glass Structure ◽

Open Heart Surgery ◽

Median Sternotomy ◽

Magic Angle Spinning ◽

Size Analysis ◽

Wound Complications ◽

Magic Angle ◽

X Ray ◽

Sternal Closure ◽

Mole Percentage

Median sternotomy surgery is the gold standard for cardiac/thoracic procedures such as open-heart surgery. With over one million median sternotomy surgeries performed worldwide every year, sternal wound complications pose a serious risk to the health of affected patients. Various techniques have been used for sternal fixation including wiring, plate-screw systems and cementing. The ideal sternal closure device is the one which has mechanical properties suited to the local environment, biocompatibility, radio-opacity, cost-effectiveness and ease of removal when necessary. None of the techniques that have been utilized for sternal fixation to date address all of these requirements. Glass polyalkenoate cements (GPCs) have a long history of use in restorative and orthodontic dentistry and ear, nose and throat (ENT) surgery but have yet to be indicated for musculoskeletal applications. This dissertation relates to the development of new GPC-based adhesives for use in sternal closure. A series of novel glasses based on the system 48SiO2-(36-X) ZnO-6CaO-8SrO-2P2O5-XTa2O5 with X varying from 0.0 to 8.0 mole percentage were fabricated and characterized. The structural features as a function of Ta2O5 content were investigated by network connectivity (NC) calculations, x-ray diffraction (XRD), particle size analysis (PSA), scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS), x-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FTIR) and magic angle spinning-nuclear magnetic resonance (MAS-NMR). The thermal properties of the glasses were obtained by performing simultaneous thermal analysis (STA). The effect of glass structure on pH and solubility was also evaluated. The formulated glasses were used to prepare GPC adhesive materials and tested for their suitability for sternal fixation. The data collected has confirmed that substituting up to 0.5 mole percentage of ZnO with Ta2O5 in the glass system under study resulted in the formation of adhesives that are deemed suitable for sternal fixation. The formulated cements, based on the use of glasses containing no greater than 0.5 mole percentage of Ta2O5 have rheology, strength, radiopacity, antibacterial and in-vitro behavior suitable for sternal fixation. To the best knowledge of the candidate, this dissertation is the first to report the use of tantalum-containing GPC-based adhesives for sternal closure. Based on the obtained results, the formulated adhesives can be used in conjunction with sternal cable ties (current standard method) to offer optimal fixation for patients and reduce post-operative complications such as bacterial infection and pain from micro-motion.

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Design & development of a novel glass polyalkenoate cement for sternal fixation and repair, in the event of median sternotomy surgery

10.32920/ryerson.14648061.v1 ◽

2021 ◽

Author(s):

Adel M.F. Alhalawani

Keyword(s):

Glass Structure ◽

Open Heart Surgery ◽

Median Sternotomy ◽

Magic Angle Spinning ◽

Size Analysis ◽

Wound Complications ◽

Magic Angle ◽

X Ray ◽

Sternal Closure ◽

Mole Percentage

Median sternotomy surgery is the gold standard for cardiac/thoracic procedures such as open-heart surgery. With over one million median sternotomy surgeries performed worldwide every year, sternal wound complications pose a serious risk to the health of affected patients. Various techniques have been used for sternal fixation including wiring, plate-screw systems and cementing. The ideal sternal closure device is the one which has mechanical properties suited to the local environment, biocompatibility, radio-opacity, cost-effectiveness and ease of removal when necessary. None of the techniques that have been utilized for sternal fixation to date address all of these requirements. Glass polyalkenoate cements (GPCs) have a long history of use in restorative and orthodontic dentistry and ear, nose and throat (ENT) surgery but have yet to be indicated for musculoskeletal applications. This dissertation relates to the development of new GPC-based adhesives for use in sternal closure. A series of novel glasses based on the system 48SiO2-(36-X) ZnO-6CaO-8SrO-2P2O5-XTa2O5 with X varying from 0.0 to 8.0 mole percentage were fabricated and characterized. The structural features as a function of Ta2O5 content were investigated by network connectivity (NC) calculations, x-ray diffraction (XRD), particle size analysis (PSA), scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS), x-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FTIR) and magic angle spinning-nuclear magnetic resonance (MAS-NMR). The thermal properties of the glasses were obtained by performing simultaneous thermal analysis (STA). The effect of glass structure on pH and solubility was also evaluated. The formulated glasses were used to prepare GPC adhesive materials and tested for their suitability for sternal fixation. The data collected has confirmed that substituting up to 0.5 mole percentage of ZnO with Ta2O5 in the glass system under study resulted in the formation of adhesives that are deemed suitable for sternal fixation. The formulated cements, based on the use of glasses containing no greater than 0.5 mole percentage of Ta2O5 have rheology, strength, radiopacity, antibacterial and in-vitro behavior suitable for sternal fixation. To the best knowledge of the candidate, this dissertation is the first to report the use of tantalum-containing GPC-based adhesives for sternal closure. Based on the obtained results, the formulated adhesives can be used in conjunction with sternal cable ties (current standard method) to offer optimal fixation for patients and reduce post-operative complications such as bacterial infection and pain from micro-motion.

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Indications and Risks of Delayed Sternal Closure After Open Heart Surgery in Neonates and Early Infants

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135111432771 ◽

2012 ◽

Vol 3 (2) ◽

pp. 229-235 ◽

Cited By ~ 6

Author(s):

Ersin Erek ◽

Yusuf Kenan Yalcinbas ◽

Yasemin Turkekul ◽

Arda Saygili ◽

Ayse Ulukol ◽

...

Keyword(s):

Heart Surgery ◽

Univariate Analysis ◽

Open Heart Surgery ◽

Morbidity Rate ◽

Wound Complications ◽

Skin Closure ◽

Sternal Closure ◽

Delayed Sternal Closure ◽

Patch Closure ◽

Mechanical Ventilation Time

Background: Delayed sternal closure (DSC) has been an essential part of neonatal and infant heart surgery. Here, we report our single institution experience of DSC for eight years. Methods: The successive 188 patients were analyzed retrospectively. Sternum was closed at the end of the operation in 97 (51.6%) patients (primary sternal closure [PSC] group). Sternum was left open in 91 (48.4%) patients. Among them, 45 (23.9%) had only skin closure (DSCs group) and 46 (24.4%) had membrane patch closure (DSC membrane [DSCm] group). Median age was higher in PSC group (90 days) than DSCs (11 days) and DSCm groups (9.5 days). Results: Mortality was 1%, 11.1%, and 28.2% in PSC, DSCs, and DSCm groups, respectively ( P < .05). Univariate analysis recognized the neonatal age (odds ratio [OR] = 4.2), preoperative critical condition (OR = 5.3), cardiopulmonary bypass time >180 minutes (OR = 4), and cross clamp time >99 minutes (OR = 3.9) as risk factors for mortality. Total morbidity rate was higher in DSCm group (73.9%) than DSCs group (51.1%) and PSC group (23.7%; P < .001). Mechanical ventilation time, intensive care unit stay, and hospital stay were longer in DSCs and DSCm groups than PSC group ( P < .001). The incidence of hospital infection was also higher in DSCs (43.5%) and DSCm (33.3%) groups than PSC group (20.6%; P < .05). But there was no difference in the incidence of sternal wound complications, including both deep and superficial (4.1%, 8.8%, and 4.4%, respectively). Conclusion: Although the risk of sternal wound complications is not different, patients who necessitate DSC (using both skin and membrane closure techniques) have more complicated postoperative course than patients with PSC.

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Delayed sternal closure: an effective procedure for life-saving in open-heart surgery

Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology ◽

10.5152/akd.2010.043 ◽

2010 ◽

Vol 10 (2) ◽

pp. 163-167 ◽

Cited By ~ 12

Author(s):

Haydar Yasa ◽

Banu Bahriye Lafci ◽

Levent Yilik ◽

Mehmet Bademci ◽

Aykut Sahin ◽

...

Keyword(s):

Heart Surgery ◽

Open Heart Surgery ◽

Effective Procedure ◽

Open Heart ◽

Sternal Closure ◽

Life Saving ◽

Delayed Sternal Closure

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Vitamin D for prevention of sternotomy healing complications: REINFORCE-D trial

Trials ◽

10.1186/s13063-020-04920-z ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Michal Čečrle ◽

Dalibor Černý ◽

Eva Sedláčková ◽

Barbora Míková ◽

Vlasta Dudková ◽

...

Keyword(s):

Clinical Trial ◽

Cardiac Surgery ◽

Heart Surgery ◽

Soft Tissues ◽

Healing Process ◽

Hospital Readmissions ◽

Open Heart Surgery ◽

Median Sternotomy ◽

Complication Rates ◽

Mechanical Lung Ventilation

Abstract Background Most cardiac surgery patients undergo median sternotomy during open heart surgery. Sternotomy healing is an arduous, very complex, and multifactorial process dependent on many independent factors affecting the sternum and the surrounding soft tissues. Complication rates for median sternotomy range from 0.5 to 5%; however, mortality rates from complications are very variable at 7–80%. Low calcidiol concentration below 80 nmol/L results in calcium absorptive impairment and carries a risk of bone loss, which is considered as a risk factor in the sternotomy healing process. The primary objective of this clinical trial is to compare the incidence of all postoperative sternotomy healing complications in two parallel patient groups administered cholecalciferol or placebo. The secondary objectives are focused on general patient recovery process: sternal bone healing grade at the end of the trial, length of hospitalization, number of days spent in the ICU, number of days spent on mechanical lung ventilation, and number of hospital readmissions for sternotomy complications. Methods This clinical trial is conducted as monocentric, randomized, double-blind, placebo-controlled, with planned enrollment of 600 patients over 4 years, approximately 300 in the placebo arm and 300 in the treatment arm. Males and females from 18 to 95 years of age who fulfill the indication criteria for undergoing cardiac surgery with median sternotomy can be included in this clinical trial, if they meet the eligibility criteria. Discussion REINFORCE-D is the first monocentric trial dividing patients into groups based on serum calcidiol levels, and with dosing based on serum calcidiol levels. This trial may help to open up a wider range of postoperative healing issues. Trial registration EU Clinical Trials Register, EUDRA CT No: 2016-002606-39. Registered on September 8, 2016.

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Association between Proliferative Scars and In-Stent Restenosis

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2007.00039 ◽

2007 ◽

Vol 11 (6) ◽

pp. 206-210 ◽

Cited By ~ 3

Author(s):

Cagdas Ozdol ◽

Sibel Turhan ◽

Cansin Tulunay ◽

A. Timucin Altin ◽

Yusuf Atmaca ◽

...

Keyword(s):

Heart Surgery ◽

Healing Process ◽

Open Heart Surgery ◽

Median Sternotomy ◽

Multivariate Logistic Regression Analysis ◽

Coronary Stenting ◽

Wound Healing Process ◽

Angiographic Restenosis ◽

Stent Restenosis ◽

In Stent Restenosis

Background: Keloid and hypertrophic scars are two types of proliferative scars at sites of cutaneous injury that form as a result of an abnormal wound-healing process. Proliferative scar formation after skin injury and restenosis after coronary stenting have common features. The aim of this study was to investigate the association of proliferative scars with coronary stent restenosis. Methods: Patients with previous open heart surgery with median sternotomy who had coronary stenting after the surgery and were admitted for control angiography were included in the study. The patients were divided into two groups according to the presence or absence of proliferative scars. The primary end point was the incidence of angiographic restenosis in patient groups. Results: The study group consisted of 80 patients (64 men; mean age 64 ± 9 years). Twenty-three patients (29%) have a proliferative scar. In general, two groups were comparable with regard to baseline lipid profiles, demographics, and cardiovascular risk factors. Restenosis was significantly more prevalent in patients with proliferative scars than with controls ( p = .04). By multivariate logistic regression analysis, stent length (odds ratio [OR] 1.12, p = .005), diabetes (OR 3.3, p = .03), and proliferative scar (OR 4.2, p = .02) independently predicted in-stent restenosis. Conclusion: The findings of this study suggest that patients with proliferative scars may have a higher risk of in-stent restenosis.

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