Açık kalp cerrahisinde geleneksel yönteme alternatif sternum kapama tekniğimiz

Yıl 2019, Cilt: 5 Sayı: 1, 1246 - 1253, 15.04.2019

Arda Aybars Pala Hasan İner Murat Abdulhamit Ercişli

https://doi.org/10.30569/adiyamansaglik.503388

Öz

Giriş: Açık
kalp cerrahisinde postoperatif süreçte görülen nadir fakat ciddi bir
komplikasyon sternal dehisenstir. Sternal dehisensi önlemek için sternumun iyi
kapatılması şarttır. Çelik tellerle sternumun birleştirilmesi konvansiyonel
sternum kapama tekniği olarak kabul görmektedir. Biz bu çalışmada, kliniğimizde
çelik teller ile uyguladığımız alternatif bir sternum kapama tekniğini ve
sonuçlarını sunmayı amaçladık.

Yöntem: Kliniğimizde
Ocak 2017 ile Ocak 2018 tarihleri arasında açık kalp cerrahisi uygulanmış 115
hastanın verileri retrospektif olarak değerlendirildi. Hastaların hepsinin
sternum kapatılması uyguladığımız alternatif teknik ile yapıldı. Hastaların
sternal dehisens için risk faktörleri ve postoperatif verileri değerlendirildi.

Bulgular: Postoperatif
süreçte %4.3 oranında yüzeysel sternal yara yeri enfeksiyonu gelişti. Hiçbir
hastada derin sternal enfeksiyon (mediastinit) ve sternal dehisens gelişmedi.
Dört hastada sternal komplikasyona bağlı olmayan mortalite görüldü. 106 hastada
(%92.1) sorunsuz olarak sternum stabilitesi ve primer yara iyileşmesi sağlandı.

Sonuç: Uyguladığımız
sternum kapama tekniğinin sternal komplikasyonları önlemede etkin ve kolay
uygulanabilir bir teknik olduğu düşüncesindeyiz.

Anahtar Kelimeler

açık kalp cerrahisi, sternal dehisens, sternum kapama

Alternative sternum closure technique to traditional method in open heart surgery

Öz

Objectives: Sternal
dehiscence is a rare but serious complication seen in postoperative period in cardiac
surgery. A good closure of the sternum is essential to prevent sternal
dehiscence. Closure of sternum by steel wires is accepted as conventional
sternal closure technique. In this study, we aimed to present an alternative
sternal closure technique and its results with steel wires in our clinic.

Methods: The
data of 115 patients who underwent open heart surgery between January 2017 and
January 2018 in our clinic were evaluated retrospectively. Sternal closure of
all patients was performed with our alternative technique. Risk factors for
sternal dehiscence and postoperative data of patients were evaluated.

Results: In
the postoperative period, superficial sternal wound infection occurred at a
rate of 4.3%. None of the patients developed deep sternal infection
(mediastinitis) and sternal dehiscence. Four patients had mortality and were
not related to sternal complications. Sternal stability and primary wound
healing were achieved in 106 patients (92.1%) without any problem.

Conclusion: We
think that our sternal closure technique is an effective and easily applicable
technique to prevent sternal complications.

Anahtar Kelimeler

open heart surgery, sternal dehiscence, sternal closure

Kaynakça

• 1. Casha AR, Yang L, Kay PH, Saleh M, Cooper GJ. A biomechanical study of median sternotomy closure techniques. Eur J Cardiothorac Surg. 1999;15(3):365-9.
• 2. Robicsek F, Fokin A, Cook J, Bhatia D. Sternal instability after midline sternotomy. Thorac Cardiovasc Surg. 2000;48(1):1-8.
• 3. Losanoff JE, Richman BW, Jones JW. Disruption and infection of median sternotomy: a comprehensive review. Eur J Cardiothorac Surg. 2002;21(5):831-9.
• 4. Cohen DJ, Griffin LV. A biomechanical comparison of three sternotomy closure techniques. Ann Thorac Surg. 2002;73(2):563-8.
• 5. Kamiya H, Al-Maisary SS, Akhyari P, Ruhparwar A, Kallenbach K, Lichtenberg A et al. The number of wires for sternal closure has a significant influence on sternal complications in high-risk patients. Interact CardioVasc Thorac Surg. 2012;15:665–70.
• 6. Alhalawani AM, Towler MR. A review of sternal closure techniques. J Biomater Appl. 2013;28(4):483-97.
• 7. Kiessling AH, Isgro F, Weisse U, Möltner A, Saggau W, Boldt J. Advanced sternal closure to prevent dehiscence in obese patients. Ann Thorac Surg. 2005;80(4):1537-9.
• 8. Molina JE, Lew RS, Hyland KJ. Postoperative sternal dehiscence in obese patients: incidence and prevention. Ann Thorac Surg. 2004;78(3):912-7.
• 9. Bryan AJ, Lamarra M, Angelini GD, West RR, Breckenridge IM. Median sternotomy wound dehiscence: a retrospective case control study of risk factors and outcome. J R Coll Surg Edinb. 1992;37(5):305-8.
• 10. Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S. Prevention and management of sternal wound infections. J Thorac Cardiovasc Surg. 2016;152:962–72.
• 11. Singh K, Anderson E, Harper JG. Overview and management of sternal wound infection. Semin Plast Surg. 2011;25(1):25-33.
• 12. Dunne B, Murphy M, Skiba R, Wang X, Ho K, Larbalestier R et al. Sternal cables are not superior to traditional sternal wiring for preventing deep sternal wound infection. Interact Cardiovasc Thorac Surg. 2016;22:594–8.
• 13. Losanoff JE, Foerst JR, Huff H, Richman BW, Collier AD, Hsieh FH, et al. Biomechanical porcine model of median sternotomy closure. J Surg Res. 2002;107(1):108-12.
• 14. Khasati N, Sivaprakasam R, Dunning J. Is the figure-of-eight superior to the simple wire technique for closure of the sternum? Interact Cardiovasc Thorac Surg. 2004;3(1):191-4.
• 15. Tekümit H, Cenal AR, Tataroğlu C, Uzun K, Akinci E. Comparison of figure-of-eight and simple wire sternal closure techniques in patients with non-microbial sternal dehiscence. Anadolu Kardiyol Derg. 2009;9(5):411-6.