Vitalitec International, The Sternal Closure Device: A novel closure technique for sternal dehiscence

Abstract

Objective: Impaired sternal wound healing remains problematic after median sternotomy and can cause to significant morbidity after cardiac surgical procedures. Although some reconstruction systems exist for sternal closure, their use is limited by expense and practicality, and simple wire closure remains the most common technique to close the sternum. In this study, we aim to discuss the results of 6 cases that underwent surgery for sternal dehiscence(SD). Methods: We reviewed six patients with sternal dehiscence who underwent surgery in our department between April 2013 and May 2014. We have used a novel closure technique in six patients with sternal dehiscence and evaluated early-term results of sternal clips plus rewiring following failed sternal closure. Results: The mean age was 63 (range, 55 to 79 years). All patients were male. We have used a novel closure technique with sternal clips plus rewiring in all patients. We evaluated six patients with non-infectious SD. Sternal reconstruction using rigid fixation with clips improve bone healing and reduce early postoperative pain. All cases were discharged with successful treatment. Conclusions: We believe that this method of sternal closure guarantees better clinical outcomes rather than sternal wire closure. Additionally, SCD(sternal closure device) clips proved to be cost effective in cardiac surgery. J Clin Exp Invest 2014; 5 (4): 534-538

Keywords

• Sternal dehiscence, closure technique, cardiac surgery

Sternal ayrılma için yeni bir kapatma tekniği: Vitalitec International, sternal kapama cihazı

Öz

Amaç: Median sternotomi sonrası bozulmuş sternal yara iyileşmesi kardiak cerrahi sonrası önemli morbidite sebebi olabilir. Sternum kapatılması için bazı teknikler mevcut olmasına rağmen pratikte sınırlıdır ve sternumu basit tel tekniği ile kapatma uygulanan en yaygın tekniktir. Bu çalışmada sternal ayrılma nedeniyle cerrahi uygulanan 6 olgunun sonuçlarını tartışmayı hedefliyoruz. Yöntemler: Nisan 2013 ile Mayıs 2014 arasında kliniğimizde sternal ayrılma nedeniyle opere edilen 6 hastaya sternal kapatma cihazı ile kapama uygulandı. Erken dönem sonuçları postop ağrı ve sternum sağlamlığı açısından değerlendirildi. Bulgular: Ortalama yaş 63 (55-79 yıl) idi. Tüm hastalar erkekti. Enfekte olmayan sternal ayrılması olan 6 hasta değerlendirildi. Tüm hastalarda sternal klipsler kullanıldı. Klipslerle yapılan sternal rekonstrüksiyonda kemik iyileşmesinin geliştiği ve erken postoperatif ağrının azaldığı gözlemlendi. Tüm olgular tedavi sonucunda başarılı bir şekilde taburcu edildi. Sonuç: Sternumun bu yöntem ile kapatılmasının tel ile kapatılmasına göre daha etkin ve daha iyi klinik sonuçlar verdiğine inanıyoruz, ayrıca kalp cerrahisinde sternal kapama klipslerin kullanılması daha düşük maliyetli olduğu görülmüştür.

Anahtar Kelimeler

• Sternal ayrılma, kapatma tekniği, kardiak cerrahi

Kaynakça

1. Katz NM. Pericostal sutures to reinforce sternal closure after cardiac surgery. J Card Surg 1997;12:277–281.
2. Robicsek F, Fokin A, Cook J, et al. Sternal instabil- ity after midline sternotomy. Thorac Cardiovasc Surg 2000;48:1–8.
3. Losanoff JE, Richman BW, Jones JW. Disruption and infection of median sternotomy: a comprehensive re- view. Eur J Cardiothorac Surg 2002;21:831–839.
4. Bryan AJ, Lamarra M, Angelini GD, et al. Median ster- notomy wound dehiscence: a retrospective case con- trol study of risk factors and outcome. J R Coll Surg Edinb 1992;37:305–308.
5. El Oakley RM, Wright JE. Postoperative mediastini- tis: classification and management. Ann Thorac Surg 1996;61:1030–1036.
6. Harjula A, Jarvinen A. Postoperative median sternot- omy dehiscence. Scand J Thorac Cardiovasc Surg 1983;17:277–281.
7. Casha AR, Yang L, Kay PH, et al. A biomechanical study of median sternotomy closure technique. Eur J Cardiothorac Surg 1999;15:365–369.
8. Antoinette MJ, Rockx BA, Fox SA, et al. Is obesity a predictor of mortality, morbidity and readmission after cardiac surgery Can J Surg 2004;1:34–38.

9. Sharma R, Puri D, Panigrahi BP, et al. A modified para- sternal wire technique for prevention and treatment of sternal dehiscence. Ann Thorac Surg 2004;77:210– 213.
10. Abid Q, Podila SR, Kendall S. Sternal dehiscence af- ter cardiac surgery and ACE type I inhibition. Eur J Cardiothorac Surg 2001;20:203–204.
11. Bitkover CY, Gardlund B. Mediastinitis after cardiovas- cular operations: a case-control study of risk factors. Ann Thorac Surg 1998;65:36–40.
12. Voss B, Bauernschmitt R, Albrecht W, et al. Sternal reconstruction with titanium plates in complicated sternal dehiscence. Eur J Cardiothorac Surg 2008, 34:139-145.
13. Milton AF, cited by Kirschner M. [Tratado de tecnica operatoria general y especial.] Barcelona: Editorial Labor, 1942;4:756–760.
14. Taber RE, Madaras O. Prevention of sternotomy wound disruptions by use of figure-of-eight pericostal sutures. Ann Thorac Surg 1969;8:367–369.
15. Grossi EA, Culliford AT, Krieger KH, et al. A survey of 77 major infectious complications of median ster- notomy: a review of 7,949 consecutive operative pro- cedures. Ann Thorac Surg 1985;40:214–223.
16. Huh J, Bakaeen F, Chu D, et al: Transverse sternal plating in secondary sternal reconstruction. J Thorac Cardiovasc Surg 2008;136:1476-1480.
17. Claus T, Kuehnel RU, Albes JM. Secondary closure of the sternum after healing of a postoperative mediasti- nitis using Sternal Closure Devices (Vitalitec Interna- tional), Fumedica Medizintechnik, 2010.