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Xie WP, Chen XH, Zhou SJ, Chen Q, Cao H. Sternal Pin Used to Close Sternum in Infants after Cardiac Surgery. Thorac Cardiovasc Surg 2024; 72:77-83. [PMID: 37230479 DOI: 10.1055/s-0043-1768967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE A retrospective study was conducted to explore the efficacy of bioabsorbable poly-L-lactic acid sternal pins in sternal closure in infants after cardiac surgery. METHODS A total of 170 infantile patients who underwent cardiac surgery were divided into the steel wire group (group A), the PDS cord group (group B), and the steel wire + sternal pin group (group C). The occurrence of the thoracic deformity was evaluated by vertebral index (VI), frontosagittal index (FSI), and Haller index (HI) values; the stability of the sternum was evaluated by detecting sternal dehiscence and displacement. RESULTS By comparing the absolute values of the differences in VI, FSI, and HI in the three groups, it was found that the difference values of VI and HI in group C were significantly lower than those in group B (p = 0.028 and 0.005). For the highest deformation index, the deformation rate of infants in group C before discharge and during the 1-year follow-up was lower than that in group A and group B (p = 0.009 and 0.002, respectively). The incidence of sternal displacement in group C was also significantly lower than that in groups A and B (p = 0.009 and 0.009). During the 1-year follow-up, there was no sternal dehiscence, and the sternum healed completely in the three groups. CONCLUSION The use of "steel wire + sternal pin" for sternal closure in infants after cardiac surgery can reduce the occurrence of sternal deformity, reduce anterior and posterior displacement of the sternum, and improve sternal stability.
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Affiliation(s)
- Wen-Peng Xie
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiu-Hua Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Si-Jia Zhou
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Matsuo S, Kobayashi K, Mizumoto M, Uchida T. Unexpected migration of a sternal pin: A word of caution. J Card Surg 2021; 37:453-454. [PMID: 34826156 DOI: 10.1111/jocs.16164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sternal pins are adjuncts used to enhance sternal stability after sternotomy, but only a few complications associated with them have been previously reported. MATERIAL, METHODS AND RESULTS A 42-year-old woman underwent pulmonary valve replacement through re-sternotomy for pulmonary valve regurgitation after repaired tetralogy of Fallot. Because of severe sternal deformity, the sternum was refixed using a sternal pin in addition to sternal wires. However, postoperative computed tomography unexpectedly revealed migration of the sternal pin towards the right coronary artery, necessitating emergency surgical removal of the pin. DISCUSSION Sternal pins may not adequately fit the deformed sternum, resulting in sternal pin-induced sternal injury. CONCLUSION Sternal pins are considered useful for sternal stabilization after sternotomy, we should take special care in applying sternal pins to patients presented severe sternal deformity.
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Affiliation(s)
- Somei Matsuo
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Kimihiro Kobayashi
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Masahiro Mizumoto
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Tetsuro Uchida
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
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Yutaka Y, Hamaji M, Toyota N, Kawabe Y, Sato T, Nakamura T, Date H. Improved Healing by Adjuvant Osteoconductive Therapy Using a Novel Cotton-Like Hydroxyapatite Sheet After Median Sternotomy. Semin Thorac Cardiovasc Surg 2020; 32:244-252. [DOI: 10.1053/j.semtcvs.2019.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 11/11/2022]
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4
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Does a good beginning make a good end? The importance of biocompatibility. J Thorac Cardiovasc Surg 2017; 154:940-941. [DOI: 10.1016/j.jtcvs.2017.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 11/20/2022]
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Tam DY, Fremes SE. Steel and bones: A perfect union? J Thorac Cardiovasc Surg 2017; 154:941-942. [PMID: 28826160 DOI: 10.1016/j.jtcvs.2017.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/05/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Goda Y, Chen-Yoshikawa TF, Kusunose M, Hamaji M, Motoyama H, Hijiya K, Aoyama A, Date H. Late-onset chest wall abscess due to a biodegradable rib pin infection after lung transplantation. Gen Thorac Cardiovasc Surg 2017; 66:175-178. [PMID: 28315045 DOI: 10.1007/s11748-017-0768-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/07/2017] [Indexed: 11/25/2022]
Abstract
A 55-year-old man with end-stage emphysema underwent a right single-lung transplantation through a posterolateral thoracotomy. The fifth rib was divided and fused back using a biodegradable pin made of polylactide acid and hydroxyapatite. Two weeks postoperatively, he suffered from central vein catheter-related sepsis due to methicillin-sensitive Staphylococcus aureus. After being successfully treated for sepsis, he was discharged. However, 3 months later, computed tomography revealed multiple loculated abscesses in the chest wall and the right pleural space. Reoperative thoracotomy revealed abscesses mainly located around the fifth rib, where the pin was inserted. Both cultures of the abscess and the fifth rib were positive for methicillin-sensitive S. aureus, which suggested that the rib pin was the cause of the secondary infection. This case suggests the rib pins, even if they are biodegradable, could have a risk of infections side effect especially for the immunosuppressed patients.
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Affiliation(s)
- Yasufumi Goda
- Departments of Thoracic Surgery, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku1, Kyoto, 606-8507, Japan
| | - Toyofumi F Chen-Yoshikawa
- Departments of Thoracic Surgery, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku1, Kyoto, 606-8507, Japan.
| | | | - Masatsugu Hamaji
- Departments of Thoracic Surgery, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku1, Kyoto, 606-8507, Japan
| | - Hideki Motoyama
- Departments of Thoracic Surgery, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku1, Kyoto, 606-8507, Japan
| | - Kyoko Hijiya
- Departments of Thoracic Surgery, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku1, Kyoto, 606-8507, Japan
| | - Akihiro Aoyama
- Departments of Thoracic Surgery, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku1, Kyoto, 606-8507, Japan
| | - Hiroshi Date
- Departments of Thoracic Surgery, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku1, Kyoto, 606-8507, Japan
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Hamaji M, Kojima F, Koyasu S, Nobashi T, Tsuruyama T, Date H, Nakamura T. A rigid and bioabsorbable material for anterior chest wall reconstruction in a canine model. Interact Cardiovasc Thorac Surg 2014; 20:322-8. [PMID: 25505306 DOI: 10.1093/icvts/ivu416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The optimal material for anterior chest wall reconstruction following chest wall resection remains controversial. The aim of this experimental study was to evaluate short-term, morphological and histological outcomes of anterior chest wall reconstruction with a rigid and bioabsorbable material in a canine model. METHODS Twenty adult beagle dogs underwent anterior chest wall resection. In the experimental group (n = 10), the anterior chest wall was reconstructed with a rigid and bioabsorbable material composed of poly-L-lactide acid matrix (60 wt%) and uncalcined and unsintered hydroxyapatite particles (40 wt%), whereas in the control group it was (n = 10) reconstructed with dual polypropylene mesh sheets. Short-term complication rates were compared with a χ(2) test. Postoperative sternal deviations were evaluated with sternal alignment angles using computed tomography and multiplanar reconstruction and were compared with Mann-Whitney U-test immediately after reconstruction, and at 1, 3, 6, 9 and 12 months postoperatively. Histological findings of the regenerated chest wall tissue were obtained after staining with haematoxylin and eosin and Elastica van Gieson (EVG) and compared at 3, 6, 9 and 12 months. RESULTS There was not a significant difference in the short-term postoperative complication rate (P = 0.53) and the complication rate was 20% (wound infection, n = 1 and lethal mediastinitis, n = 1) in the control group and 10% (wound infection, n = 1) in the experimental group. The postoperative sternal deviation was significantly less remarkable at 1 month (123.3 ± 32.2° vs 159.4 ± 19.7°, P = 0.027), 3 months (109.8 ± 34.7° vs 150.9 ± 34.2°, P = 0.039) and 12 months (61 ± 15.6° vs 170.3 ± 6.6°, P = 0.046) in the experimental group than in the control group, whereas no significant difference was noted immediately after reconstruction (165.7 ± 6.4° vs 168.4 ± 9.1°, P = 0.50). Histological findings showed dense connective tissue in the regenerated chest wall in both groups and showed chondroblasts in the regenerated chest wall tissue at 3 and 6 months only in the experimental group. CONCLUSIONS Our results suggest that anterior chest wall reconstruction with a rigid and bioabsorbable material is feasible and may be a valuable alternative to reconstruction with a non-rigid and non-absorbable material.
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Affiliation(s)
- Masatsugu Hamaji
- Department of Bioartificial Organs, Graduate School of Medicine, Kyoto University, Kyoto, Japan Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fumitsugu Kojima
- Department of Bioartificial Organs, Graduate School of Medicine, Kyoto University, Kyoto, Japan Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sho Koyasu
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomomi Nobashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuaki Tsuruyama
- Center for Anatomical, Pathological and Forensic Medical Researches, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuo Nakamura
- Department of Bioartificial Organs, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Kawashima M, Sano A, Tanaka M. Sternal closure with absorbable pins and cords in general thoracic surgery. Surg Today 2014; 45:929-31. [PMID: 25432301 DOI: 10.1007/s00595-014-1092-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/07/2014] [Indexed: 10/24/2022]
Abstract
After median sternotomy, the sternum is commonly closed using metal wires, which sometimes cause complications because they are permanent foreign bodies. As an alternative, we used a combination of absorbable sutures and pins for full median sternotomy in 24 adult general thoracic surgery patients. There were three cases of sternal dehiscence detectable by computed tomography, none of which required re-operation. Two of these patients had diabetes mellitus (DM) and the third patient was on corticosteroid therapy. In an appropriately selected patient population that excludes patients with DM or who are undergoing corticosteroid therapy, we have not observed any sternal complications. We concluded that our technique is clinically feasible with appropriate patient selection.
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Affiliation(s)
- Mitsuaki Kawashima
- Department of Thoracic Surgery, Chigasaki Municipal Hospital, Honson 5-15-1, Chigasaki, Kanagawa, 253-0042, Japan
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Inan B, Kucukdurmaz F, Karakan S, Teker ME, Akcan C, Dilek GB, Daglioglu K. Straight versus S-shaped sternotomy: a histologic study in the sheep model. J Cardiothorac Surg 2014; 9:173. [PMID: 25359502 PMCID: PMC4219003 DOI: 10.1186/s13019-014-0173-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/10/2014] [Indexed: 08/30/2023] Open
Abstract
Introduction Straight sternotomy is the most common access for open heart surgery. Techniques have been proposed for maximizing sternal stability in high-risk patients. This trend implies a growing need for newer surgical techniques. The aim of this experimental study in the sheep model is to evaluate median vs. S shaped sternotomy the feasibility of using a special device to accelerate the sternal instability and bone healing. Materials and methods We enrolled 31 sheep, weighing 18–30 kg. For all animals a midline skin incision was made. In group I (n = 16 animals), straight median sternotomy and in group II (n = 15 animals), S-shaped incision was marked on the periosteum of the sternum by new created device for standard S-shaped sternotomy. Sternum biopsies were performed on second surgery month for all survived animals from the sternum and the surrounding soft tissue. Results No early superficial wound complications were observed. Overall mortality in the initial approach group was 19.3% (6 sheep). In group I; 3 sheep had died on first surgery day, the reason may be hemorrhage and in group II; 3 sheep developed intractable VF during surgery procedure or immediately afterwards so died. There were statistically significant differences in the scores of bone healing between group 1 and group 2 (4.2 vs.7.3, ANOVA, p < 0.001). Discussion Our work is based on the use of a standard S-shaped sternotomy procedure on sheep sternum. In our experience with the sternal healing in the sheep model, the process of new bone formation was accelerated with S- shaped cut than straight sternotomy procedure. Electronic supplementary material The online version of this article (doi:10.1186/s13019-014-0173-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bekir Inan
- Department of Cardiovascular Surgery, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey.
| | - Fatih Kucukdurmaz
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Istanbul, Turkey.
| | - Sebnem Karakan
- Department of Nephrology, Ankara Oncology Education and Research Hospital, Ankara, Turkey.
| | - Melike E Teker
- Department of Cardiovascular Surgery, Malatya State Hospital, Malatya, Turkey.
| | - Caner Akcan
- Department of CAE and Methodology Development, SDM Research and Engineering, Istanbul, Turkey.
| | - Gulay B Dilek
- Department of Pathology, Ankara Oncology Education and Research Hospital, Ankara, Turkey.
| | - Kenan Daglioglu
- Department of Microbiology, Cukurova University, Adana, Turkey.
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Kawamura M, Masai T, Matsue H, Yoshikawa Y, Sawa Y. Analysis of the sternum for sternal closure with bioabsorbable sternal pins. Asian Cardiovasc Thorac Ann 2014; 21:331-4. [PMID: 24570501 DOI: 10.1177/0218492312460772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Poly-L-lactide sternal pins have been reported to be beneficial for sternal closure. However, we sometimes experience a small sternum, and the size characteristics of the sternum have not been fully investigated. We analyzed size features of the sternum to determine the optimal size of sternal pin for sternal closure. METHODS Chest computed tomography scans were preoperatively obtained in 144 patients undergoing major cardiovascular surgery. We reviewed all scans at the level of the sternum, and measured the width of the bone marrow of the sternum on each computed tomography slice. RESULTS The mean values of bone marrow width of the sternal manubrium and body of male patients were significantly higher than those of females (manubrium: 38.6 ± 3.9 mm in males, 34.5 ± 3.3 mm in females, p < 0.0001; body: 23.4 ± 3.7 mm in males, 20.8 ± 2.8 mm in females, p < 0.0001). There was no correlation between the bone marrow width of the sternal body and body surface area in either males or females (males: r = 0.08, p = 0.45, females: r = 0.08, p = 0.58). CONCLUSION To select the appropriate size of sternal pin, preoperative measurement of the bone marrow width of the sternum is recommended because it cannot be predicted from body size.
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Affiliation(s)
- Masashi Kawamura
- Department of Cardiovascular Surgery, Sakurabashi-Watanabe Hospital, Osaka, Japan
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Landes C, Ballon A, Ghanaati S, Tran A, Sader R. Treatment of malar and midfacial fractures with osteoconductive forged unsintered hydroxyapatite and poly-L-lactide composite internal fixation devices. J Oral Maxillofac Surg 2014; 72:1328-38. [PMID: 24704037 DOI: 10.1016/j.joms.2014.02.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 02/17/2014] [Accepted: 02/17/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the internal fixation of malar and midfacial fractures, long-term results, and biocompatibility of osteoconductive internal fixation devices composed of a forged composite of unsintered hydroxyapatite and poly-L-lactide (F-u-HA/PLLA). MATERIALS AND METHODS From January 2006 to June 2010, 29 patients (24 males and 5 females; age 33 ± 15 years) were included in the present prospective study. The fracture type was malar in 24 patients, midfacial in 5, isolated orbital floor blowout in 2, and frontal sinus, cranial base in 2 patients. The fractures were fixed with internal fixation devices; these were plates and screws composed of F-u-HA/PLLA. The 24 patients with malar fractures were treated with a single 4-hole L-plate or a straight plate at the infrazygomatic crest. RESULTS All fractures with internal fixation using devices composed of F-u-HA/PLLA healed well. All malar and midfacial fractures had satisfactory long-term stability. The follow-up examinations at 12 to 67 months after surgery showed that most patients had no complaints, although 2 patients (15%) had a foreign body reaction that was treated by implant removal, with complete symptom resolution. At 5 years after fracture fixation, 2 patients had ultrasound and 2 had radiographic evidence of residual material. An exemplar biopsy showed direct bone growth into the material. CONCLUSIONS In patients with malar and midfacial fractures, hardware composed of the F-u-HA/PLLA composite provided reliable and satisfactory internal fixation, intraoperative handling, long-term stability, and biocompatibility. Direct bone growth into the material could be histopathologically exemplified, in contrast to previous polymer fixations that were resorbed and surrounded by a connective tissue layer. This finding indicates that long-term F-u-HA/PLLA residual material will be included into the remodeled bone, which was confirmed on long-term follow-up radiographs.
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Affiliation(s)
- Constantin Landes
- Professor, Department of Oral-Craniofacial and Plastic Facial Surgery, Goethe University, Hospital Frankfurt am Main, Frankfurt am Main, Germany.
| | - Alexander Ballon
- Consultant, Department of Oral-Craniofacial and Plastic Facial Surgery, Goethe University, Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Sharam Ghanaati
- Consultant, Department of Oral-Craniofacial and Plastic Facial Surgery, Goethe University, Hospital Frankfurt am Main, Frankfurt am Main, Germany; and Institute of Pathology, Laboratory for Regenerative Pathology and Interface Research, Johannes Gutenberg University, Mainz, Germany
| | - Andreas Tran
- Research Fellow, Department of Oral-Craniofacial and Plastic Facial Surgery, Goethe University, Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Robert Sader
- Professor and Chair, Department of Oral-Craniofacial and Plastic Facial Surgery, Goethe University, Hospital Frankfurt am Main, Frankfurt am Main, Germany
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A comparative study of two types of sternal pins used for sternal closure: poly-l-lactide sternal pins versus uncalcined hydroxyapatite poly-l-lactide sternal pins. J Artif Organs 2013; 16:458-63. [DOI: 10.1007/s10047-013-0727-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 08/15/2013] [Indexed: 11/25/2022]
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Rupprecht L, Schmid C. Deep sternal wound complications: an overview of old and new therapeutic options. Open J Cardiovasc Surg 2013; 6:9-19. [PMID: 25512698 PMCID: PMC4222320 DOI: 10.4137/ojcs.s11199] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Deep sternal wound complications represent a significant problem in current open heart surgery and still pose a tremendous challenge to surgeons. Over the years, many treatment modalities have been proposed, but only few found their way into daily clinical practice of cardiothoracic surgeons. A gold standard has not been defined yet. This review was designed to give an overview of the preferred surgical strategies.
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Affiliation(s)
- Leopold Rupprecht
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
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Tsunekawa T, Usui A, Oshima H, Mizutani S, Araki Y, Okada N, Ueda Y. A bioresorbable osteosynthesis device can induce an earlier sternal fusion after median sternotomy. Interact Cardiovasc Thorac Surg 2012; 15:377-81. [PMID: 22623628 DOI: 10.1093/icvts/ivs151] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We examined the impact of the bioresorbable osteosynthesis sternal pin (Super Fixsorb 30) on sternal healing after median sternotomy. METHODS Sixty-three patients who underwent aortic surgery through median sternotomy between January 2006 and March 2009 were analysed. Sternal pins were utilized in 36 patients in addition to the standard closure of the sternum with Ethibond sutures (Group A), and 27 patients received no pins with the standard Ethibond sternal closure (Group B). The occurrence of transverse sternal dehiscence, anterior-posterior displacement and complete fusion of the sternum were evaluated by a computed tomography scan. The cross-sectional cortical bone density area (CBDA) of the sternum was examined to evaluate the osteoconductivity of the sternal pin over a 12-month period. RESULTS There was no sternal displacement (0%) observed in Group A at discharge. Meanwhile, five displacements (18.5%) were observed in Group B (P = 0.007). The complete sternal fusion rates at 12 months postoperatively were 100% in Group A, and 21.6% in Group B (P < 0.001). A significant increase in the CBDA was observed in Group A (P < 0.001; between CBDA at discharge and 12 months postoperatively). CONCLUSIONS The Super Fixsorb 30 sternal pin reduced an anterior-posterior sternal displacement and facilitated an earlier sternal fusion. The pin may have the potential to promote osteogenesis.
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Affiliation(s)
- Tomohiro Tsunekawa
- Department of Cardiovascular Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Gallo I, Sáenz A, Artiñano E, Esquide J. Autologous platelet-rich plasma: effect on sternal healing in the sheep model. Interact Cardiovasc Thorac Surg 2010; 11:223-5. [DOI: 10.1510/icvts.2010.237776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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de Bucourt M, Swierzy M, Ismail M, Gregor J, Webler M, Rückert JC. A novel sternal closure technique with implants suitable for complex dehiscences. Surg Innov 2010; 17:353-5. [PMID: 20699299 DOI: 10.1177/1553350610378516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A novel sternum stabilization implant system is presented in a complex clinical case with previous pseudarthroses. The authors used the advanced closure system Sternal Talon of KLS Martin group and arranged 1 double and 2 single implants in an atypical fashion to fit the patient's needs. One year later follow up has not revealed any recurrence of pain or pseudarthrotic signs such as crepitation.
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