Research Article
BibTex RIS Cite

Yüksek Riskli Hastalarda Poliglikonat (Maxon) Sütürle Desteklenen Sternum Kapama Tekniğinin Aseptik Sternal Ayrışma Üzerine Etkisi

Year 2015, Volume: 18 Issue: 1, 15 - 18, 06.04.2015

Abstract











Giriş: Sternal
ayrışma, kardiyak cerrahi sonrası ciddi bir komplikasyondur. Bu çalışmanın
temel amacı yüksek riskli hastalarda poliglikonat sütür (Maxon) ile desteklenen
sternum kapama tekniğinin sternal ayrışmayı önlemedeki etkinliğinin
araştırılmasıdır.



Hastalar ve Yöntem: Bu
retrospektif çalışmaya, (Aralık 2011-Ocak 2013), kardiyak cerrahi için standart
median sternotomi uygulanan 136 hasta dahil edildi. Tüm hastalar sternal
ayrışma için obezite, osteoporoz, kronik obstrüktif akciğer hastalığı, kronik aktif
sigara içiciliği gibi bir veya daha fazla risk faktörüne sahipti. Tüm
hastalarda sternum kapatılması esnasında çelik tele ilave olarak interkostal
aralıklardan geçilerek poliglikonat sütürler konuldu.



Bulgular: Hiçbir hastada
sternal ayrışma veya mediastinit görülmedi. Sadece 3 hastada (%2.2), sternal
ayrışma olmadan sternum alt kısmında yüzeysel yara infeksiyonu gözlendi ve
bunlar da antibiyotik tedavisi ile başarıyla tedavi edildi.



Sonuç: Bu çalışma, yüksek riskli
hastalarda, klasik çelik tele ilave olarak interkostal aralıklardan
poliglikonat sütürler geçilerek desteklenen sternum kapama yönteminin sternal
stabiliteyi artırdığını ve aseptik sternal ayrışmayı önlediğini göstermektedir.

References

  • 1. Molina JE, Lew RS, Hyland KJ. Postoperative sternal dehiscence in obese patients: Incidence and prevention. Ann Thorac Surg 2004;78:912-7.
  • 2. Celik S, Kirbas A, Gurer O, Yildiz Y, Isik O. Sternal dehiscence in patients with moderate and severe chronic obstructive pulmonary disease undergoing cardiac surgery: The value of supportive thorax vests. J Thorac Cardiovasc Surg 2011;141:1398-402.
  • 3. 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.
  • 4. Schimmer C, Reents W, Elert O. Primary closure of median sternotomy: A survey of all German surgical heart centers and a review of the literature concerning sternal closure technique. Thorac Cardiovasc Surg 2006;54:408-13.
  • 5. Hamaji M, Sakaguchi Y, Matsuda M, Kono S. Reinforced closure of the sternum with absorbable pins for high-risk patients. Interact Cardiovasc Thorac Surg 2009;9:559-61.
  • 6. Riess FC, Awwad N, Hoffmann B, Bader R, Helmold HY, Loewer C, et al. A steel band in addition to 8 wire cerclages reduces the risk of sternal dehiscence after median sternotomy. Heart Surg Forum 2004;7:387-92.
  • 7. Robicsek F, Daugherty HK, Cook JW. The prevention and treatment of sternum separation following open-heart surgery. J Thorac Cardiovasc Surg 1977;73:267-8.
  • 8. Raman J, Lehmann S, Zehr K, De Guzman BJ, Aklog L, Garrett HE, et al. Sternal closure with rigid plate fixation versus wire closure: A randomized controlled multicenter trial. Ann Thorac Surg 2012;94:1854-61.
  • 9. Guler A, Durukan AB, Gurbuz HA, Tavlasoglu M, Sahin MA, Jahollari A, et al. Efficacy of thermoreactive nitinol clip implantation in reconstruction of sternal dehiscence. Heart Surg Forum 2012;15:E280-3.
  • 10. Tewarie LS, Menon AK, Hatam N, Amerini A, Moza AK, Autschbach R, et al. Prevention of sternal dehiscence with the sternum external fixation (Stern-E-Fix) corset-a randomized trial in 750 patients. J Cardiothorac Surg 2012;7:85.
  • 11. Fedak PW, Kasatkin A. Enhancing sternal closure using Kryptonite bone adhesive: Technical report. Surg Innov 2011;18:NP8-11.
  • 12. Franco S, Herrera AM, Atehortúa M, Vélez L, Botero J, Jaramillo JS, et al. Use of steel bands in sternotomy closure: İmplications in high-risk cardiac surgical population. Interact Cardiovasc Thorac Surg 2009;8:200-5.
  • 13. Tekümit H, Cenal AR, Tataroğlu C, Uzun K, Akıncı E. Comparison of figure-of-eight and simple wire sternal closure techniques in patients with non-microbial sternal dehiscence. Anadolu Kardiyol Derg 2009;9: 411-6.
  • 14. Luciani N, Anselmi A, Gandolfo F, Gaudino M, Nasso G, Piscitelli M, et al. Polydioxanone sternal sutures for prevention of sternal dehiscence. J Card Surg 2006;21:580-4.
  • 15. Hochberg J, Meyer KM, Marion MD. Suture choice and other methods of skin closure. Surg Clin North Am 2009;89:627-41.

Effects of Polyglyconate (Maxon) Suture Reinforced Sternum Closure Technique on Aseptic Sternal Dehiscence in High Risk Patients

Year 2015, Volume: 18 Issue: 1, 15 - 18, 06.04.2015

Abstract











Introduction: Sternal dehiscence is a
serious complication after cardiac surgery. The main objective of this study
will be to determine the effects of polyglyconate suture (Maxon) reinforced
sternum closure technique on prevention of aseptic sternal dehiscence in
high-risk patients.



Patients and Methods: This retrospective study
(December 2011 to January 2013) comprised 136 consecutive patients undergoing standard
median sternotomy for cardiac procedures. All of these patients have one or
more risk factor of sternal dehiscence such as obesity, osteoporosis, chronic
obstructive pulmonary disease and chronic active cigarette smoker. In all
patients, in addition to steel wire during sternal closure polyglyconate
sutures were placed, passing through the intercostal space.



Results: No sternal dehiscence or
mediastinit occurred these patients. Only 3 patients (2.2%) were observed
superficial wound infection at lower part of sternum without sternum dehiscence
and treated successfully by antibiotic therapy.



Conclusion: This study shows that
besides the classic steel wire, additional polyglyconate sutures placed
intercostal spaces can be inhance sternum stability and prevent aseptic sternal
dehiscence in high risk patients.



References

  • 1. Molina JE, Lew RS, Hyland KJ. Postoperative sternal dehiscence in obese patients: Incidence and prevention. Ann Thorac Surg 2004;78:912-7.
  • 2. Celik S, Kirbas A, Gurer O, Yildiz Y, Isik O. Sternal dehiscence in patients with moderate and severe chronic obstructive pulmonary disease undergoing cardiac surgery: The value of supportive thorax vests. J Thorac Cardiovasc Surg 2011;141:1398-402.
  • 3. 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.
  • 4. Schimmer C, Reents W, Elert O. Primary closure of median sternotomy: A survey of all German surgical heart centers and a review of the literature concerning sternal closure technique. Thorac Cardiovasc Surg 2006;54:408-13.
  • 5. Hamaji M, Sakaguchi Y, Matsuda M, Kono S. Reinforced closure of the sternum with absorbable pins for high-risk patients. Interact Cardiovasc Thorac Surg 2009;9:559-61.
  • 6. Riess FC, Awwad N, Hoffmann B, Bader R, Helmold HY, Loewer C, et al. A steel band in addition to 8 wire cerclages reduces the risk of sternal dehiscence after median sternotomy. Heart Surg Forum 2004;7:387-92.
  • 7. Robicsek F, Daugherty HK, Cook JW. The prevention and treatment of sternum separation following open-heart surgery. J Thorac Cardiovasc Surg 1977;73:267-8.
  • 8. Raman J, Lehmann S, Zehr K, De Guzman BJ, Aklog L, Garrett HE, et al. Sternal closure with rigid plate fixation versus wire closure: A randomized controlled multicenter trial. Ann Thorac Surg 2012;94:1854-61.
  • 9. Guler A, Durukan AB, Gurbuz HA, Tavlasoglu M, Sahin MA, Jahollari A, et al. Efficacy of thermoreactive nitinol clip implantation in reconstruction of sternal dehiscence. Heart Surg Forum 2012;15:E280-3.
  • 10. Tewarie LS, Menon AK, Hatam N, Amerini A, Moza AK, Autschbach R, et al. Prevention of sternal dehiscence with the sternum external fixation (Stern-E-Fix) corset-a randomized trial in 750 patients. J Cardiothorac Surg 2012;7:85.
  • 11. Fedak PW, Kasatkin A. Enhancing sternal closure using Kryptonite bone adhesive: Technical report. Surg Innov 2011;18:NP8-11.
  • 12. Franco S, Herrera AM, Atehortúa M, Vélez L, Botero J, Jaramillo JS, et al. Use of steel bands in sternotomy closure: İmplications in high-risk cardiac surgical population. Interact Cardiovasc Thorac Surg 2009;8:200-5.
  • 13. Tekümit H, Cenal AR, Tataroğlu C, Uzun K, Akıncı E. Comparison of figure-of-eight and simple wire sternal closure techniques in patients with non-microbial sternal dehiscence. Anadolu Kardiyol Derg 2009;9: 411-6.
  • 14. Luciani N, Anselmi A, Gandolfo F, Gaudino M, Nasso G, Piscitelli M, et al. Polydioxanone sternal sutures for prevention of sternal dehiscence. J Card Surg 2006;21:580-4.
  • 15. Hochberg J, Meyer KM, Marion MD. Suture choice and other methods of skin closure. Surg Clin North Am 2009;89:627-41.
There are 15 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Investigations
Authors

Emin Can Ata This is me

Yüksel Dereli

Publication Date April 6, 2015
Published in Issue Year 2015 Volume: 18 Issue: 1

Cite

Vancouver Ata EC, Dereli Y. Effects of Polyglyconate (Maxon) Suture Reinforced Sternum Closure Technique on Aseptic Sternal Dehiscence in High Risk Patients. Koşuyolu Heart Journal. 2015;18(1):15-8.