APPROACHES TO STERNAL OSTEOSYNTHESIS IN POSTSTERNOTOMY COMPLICATIONS MANAGEMENT
https://doi.org/10.29001/2073-8552-2016-31-3-26-32
Abstract
Failure of sternal suture after median sternotomy is a severe cardiac surgery complication causing respiratory dysfunction and contributing to superficial and mediastinal infection affecting patients’ survival. Perioperative risk factors for sternal dehiscence include the approaches to sternal osteosynthesis and type of suture material. To improve respiratory biomechanics and quality of life in patients with postoperative sternal instability without infection as well as in patients with postoperative sterno mediastinitis, sternal osteosynthesis is a relevant final step of treatment after elimination of the infection. To achieve that, various suture and wound closure materials are used. Stainless steel wire or polyester material sternal sutures are common, but they are often cheese wire tissues due to chest motions leading to cascade of complications and requiring reoperations. Therefore, new approaches and systems for restoration of sternal integrity continue to be developed. This article reviews currently available sternal resynthesis methods used for treatment and prevention of sternal sternotomy complications.
About the Authors
M. V. Shvedova
Siberian State Medical University;
RASA Center in Tomsk, National Research Tomsk Polytechnic University
Russian Federation
Tomsk
Russian Federation
Tomsk
Y. Anfinogenova
Siberian State Medical University;
RASA Center in Tomsk, National Research Tomsk Polytechnic University;
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
Russian Federation
Tomsk
Russian Federation
Tomsk
G. Ts. Dambaev
Siberian State Medical University, Tomsk
Russian Federation
Tomsk
Russian Federation
Tomsk
A. N. Vusik
Siberian State Medical University, Tomsk
Russian Federation
Tomsk
Russian Federation
Tomsk
References
1. Шведова М.В., Вусик А.Н., Дамбаев Г.Ц. и др. Восстановление целостности грудины у пациентов с послеоперационным стерномедиастинитом // Сибирский медицинский журнал (Томск). – 2014. – № 4(29). – С. 45–51.
2. Шведова М.В., Дамбаев Г.Ц., Вусик А.Н. и др. Опыт хирургического лечения глубоких послеоперационных осложнений срединной стернотомии // Казанский медицинский журнал. – 2014. – №6 (95). – С. 811–816.
3. Casha A.R., Yang L., Kay P.H. et al. A biomechanical study of median sternotomy closure techniques // Eur. J. Cardiothorac. Surg. – 1999. – Vol. 15. – P. 365–369.
4. Fu X.M., Oshima H., Araki Y. et al. 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. – Vol. 16(4). – P. 458–463.
5. Sharma R., Puri D., Panigrahi B.P. et al. A modified parasternal wire technique for prevention and treatment of sternal dehiscence // Ann. Thorac. Surg. – 2004. – Vol. 77(1). – P. 210–213.
6. Grapow M.T., Melly L.F., Eckstein F.S. et al. A new cable-tie based sternal closure system: description of the device, technique of implantation and first clinical evaluation [Electronic resource] // J. Cardiothorac. Surg. – 2012. – Vol. 7. – P. 59.
7. Lafci G., Yasar E., Cicek O.F. et al. A novel modified Robicsek technique for sternal closure: “Double-check” // Asian Cardiovasc. Thorac. Ann. – 2013. – Vol. 22(6). – P. 758–760.
8. Arnoni R.T., Dantas D.C., Arnoni A. et al. Assessment of sternal closure using titanium plate [Electronic resource] // Rev. Bras. Cir. Cardiovasc. – 2013. – Vol. 28(3). – P. 386–390.
9. Wilson R.M., Ghareeb P.A., McClellan W.T. et al. Biomechanical analysis of the FlatWire Figure 8 sternal fixation device // Can. J. Plast. Surg. – 2014. – Vol. 22(3). – P. 188–190.
10. Losanoff J.E., Collier A.D., Wagner-Mann C.C. et al. Biomechanical comparison of median sternotomy closures // Ann. Thorac. Surg. – 2004. – Vol. 77. – P. 203–209.
11. Boustany A.N., Ghareeb P., Lee K. Prospective, randomized, single-blinded pilot study of a new FlatWire based sternal closure system [Electronic resource] // J. Cardiothorac. Surg. – 2014. – Vol. 9. – P. 97.
12. Broadhurst J., Moorjani N., Ohri S. Traumatic fracture of nitinol thermoreactive sternal clips // Interact. Cardiovasc. Thorac. Surg. – 2010. – Vol. 10(3). – P. 465–466.
13. Chang E.I., Festekjian J.H., Miller T.A. et al. Chest wall reconstruction for sternal dehiscence after open heart surgery [Electronic resource] // Ann. Plast. Surg. – 2013. – Vol. 71(1). – P. 84–87.
14. Olbrecht V.A., Barreiro C.J., Bonde P.N. et al. Clinical outcomes of noninfectious sternal dehiscence after median sternotomy / / Ann. Thorac. Surg. – 2006. – Vol. 82(3). – P. 902–907.
15. Spindler N., Lehmann S., Steinau H.U. et al. Complication management after interventions on thoracic organs: deep sternal wound infections [Electronic resource] // Chirurg. – 2015. – Vol. 86(3). – P. 228–233.
16. Tavlasoglu M., Kurkluoglu M., Arslan Z. et al. Detachment and dislocation of thermoreactive clips from sternum in late postoperative period due to misuse // Interact. Cardiovasc. Thorac. Surg. – 2012. – Vol. 14(4). – P. 491–493.
17. Ennker I.C., Ennker J.C. Management of sterno mediastinitis // HSR Proc. Intensive Care Cardiovasc. Anesth. – 2012. – Vol. 4(4). – P. 233–241.
18. Phan T.Q., Depner C., Theodorou P. et al. Failure of secondary wound closure after sternal wound infection following failed initial operative treatment: Causes and treatment [Electronic resource] // Ann. Plast. Surg. – 2012. – Vol. 70, No. 2. – P. 216–221.
19. Ersoy C., Ozyuksel A., Malkoc M. et al. Fibula allograft sandwich technique for the reconstruction of sternal nonunion after cardiac surgery [Electronic resource] // Ann. Thorac. Surg. – 2014. – Vol. 98(2). – P. e51–e53.
20. Iida H., Sunazawa T., Doi A. Feasibility of the use of absorbable sutures for closure of the sternum in adult cardiac surgery // Kyobu Geka. – 2013. – Vol. 66(13). – P. 1145–1148.
21. Tocco M.P., Costantino A., Ballardini M. et al. Improved results of the vacuum assisted closure and Nitinol clips sternal closure after postoperative deep sternal wound infection // Eur. J. Cardiothorac. Surg. – 2009. – Vol. 35(5). – P. 833–838.
22. Kawashima M., Sano A., Tanaka M. Sternal closure with absorbable pins and cords in general thoracic surgery // Surg. Today. – 2014. – Vol. 45(7). – P. 929–931.
23. Bryan A.J., Lamarra M., Angeline G.D. et al. Median sternotomy wound dehiscence. A retrospective case control study of risk factors and outcome // J. Coll. Surg. Edinburg. – 1992. – Vol. 37. – P. 305–308.
24. Motomatsu Y., Imasaka K., Tayama E. et al. Midterm results of sternal band closure in open heart surgery and risk analysis of sternal band removal [Electronic resource] // Artif. Organs. – 2016. – Vol. 40(2). – P. 153–158.
25. Tavilla G., van Son J.A., Verhagen A.F. et al. Modified Robicsek technique for complicated sternal closure // Ann. Thorac. Surg. – 1991. – Vol. 62(5). – P. 1179–1180.
26. Rothstein W., Spata T., Whitson B. et al. Multidimensional sternal fixation to overcome a “floating” sternum [Electronic resource] // Case Rep. Surg. – 2014. – Vol. 2014. – P. 430–434.
27. Nazerali R.S., Hinchcliff K., Wong M.S. Rigid fixation for the prevention and treatment of sternal complications [Electronic resource] // Ann. Plast. Surg. – 2014. – Vol. 72, Suppl 1. – P. 27–30.
28. Reiss N., Schuett U., Kemper M. et al. New method for sternal closure after vacuum assisted therapy in deep sterna infections after cardiac surgery // Ann. Thorac. Surg. – 2007. – Vol. 83. – P. 2246–2247.
29. Plass A., Grunenfelder J., Reuthebuch O. et al. New transverse plate fixation system for complicated sternal wound infection after median sternotomy // Ann. Thorac. Surg. – 2007. – Vol. 83. – P. 1210–1212.
30. Bejko J., Tarzia V., Franceschi M.D. et al. Nitinol Flexigrip sternal closure system and chest wound infections: Insight from a comparative analysis of complications and costs [Electronic resource] // Ann. Thorac. Surg. – 2012. – Vol. 94(6). – P. 1848–1853.
31. Gucu A., Toktas F., Eris C. et al. Nitinol thermoreactive clips for secondary sternal closure in cases of noninfective sternal dehiscence // Tex. Heart Inst. J. – 2012. – Vol. 39(4). – P. 513–516.
32. Ooi A., Franklin D., Ohri S. Improved technique of nitinol sternal clip application // Ann. Thorac. Surg. – 2009. – Vol. 87(6). – P. 1971–1972.
33. Sa M.P., Silva D.O., Lima E.N. et al. Postoperative mediastinitis in cardiovascular surgery postoperation. Analysis of 1038 consecutive surgeries // Rev. Bras. Cir. Cardiovasc. – 2010. – Vol. 25(1). – P. 19–24.
34. Meeks M.D., Lozekoot P.W., Verstraeten S.E. et al. Poststernotomy mediastinitis and the role of broken steel wires: retrospective study // Innovations (Phila). – 2013. – Vol. 8(3). – P. 219–224.
35. Taramasso M., Pozzoli A., Maisano F. et al. Post traumatic symmetrical diastasis after sternal synthesis with nitinol clips // Eur. J. Cardiothorac. Surg. – 2012. – Vol. 42(6). – P. 1050.
36. Song D.H., Lohman R.F., Renucci J.D. et al. Primary sternal plating in high risk patients mediastinitis // Eur. J. Cardiothorac. Surg. – 2004. – Vol. 26(2). – P. 367–372.
37. Snyder C.W., Graham L.A., Byers R.E. et al. Primary sternal plating to prevent sternal wound complications after cardiac surgery: early experience and patterns of failure // Interact. Cardiovasc. Thorac. Surg. – 2009. – Vol. 9(5). – P. 763–766.
38. Negri A., Manfredi J., Terrini A. et al. Prospective evaluation of a new sternal closure method with thermoreactive clips // Eur. J. Cardiothorac. Surg. – 2002. – Vol. 22. – P. 571–575.
39. Kalбb M., Karkoљka J., Kamнnek M. et al. Reconstruction of massive post-sternotomy defects with allogeneic bone graft: four-year results and experience using the method // Interact. Cardiovasc. Thorac. Surg. – 2016. – Vol. 22(3). – P. 305–313.
40. Lusini M., Di Martino A., Spadaccio C. et al. Resynthesis of sternal dehiscence with autologous bone graft and autologous platelet gel // J. Wound Care. – 2012. – Vol. 21(2). – P. 76–77.
41. Robicsek F., Daugherty H.K., Cook J.W. The prevention and treatment of sternum separation following open heart surgery // J. Thorac. Cardiovasc. Surg. – 1977. – Vol. 73. – P. 267–268.
42. Zor M.H., Acipayam M., Bayram H. et al. Single stage repair of the anterior chest wall following sternal destruction complicated by mediastinitis // Surg. Today. – 2013. – Vol. 44(8). – P. 1476–1482.
43. Centofanti P., La Torre M., Barbato L. et al. Sternal closure using semi-rigid fixation with thermo reactive clips // Ann. Thorac. Surg. – 2002. – Vol. 74. – P. 943–945.
44. DeLong M.R., Hughes D.B., Gaca J.G. et al. Sternal talon offers a solution for secondary sternum osteosynthesis in patients with nonunion // Ann. Thorac. Surg. – 2014. – Vol. 98(5). – P. 1804–1808.
45. Prantl L., Gehmert S., Nerlich M. et al. Successful reconstruction of sternum with a scapular autograft segment: 5 year follow up // Ann. Thorac. Surg. – 2011. – Vol. 92(5). – P. 1889–1891.
46. Kalab M., Karkoska J., Kaminek M. et al. Successful three-year outcome in a patient with allogenous sternal bone graft in the treatment of massive post-sternotomy defects // Int. J. Surg. Case Rep. – 2015. – Vol. 7. – P. 6–9.
47. Vohra H.A., Whistance R.N., Bolgeri M. et al. The application of nitinol thermoreactive Flexigrips for late post-cardiac surgery sternal instability // J. Thorac. Cardiovasc. Surg. – 2010. – Vol. 139(2). – P. 497–499.
48. Avlonitis V.S., Shrivastava V., Wallis J. et al. Thermoreactive clips for sternotomy closure in sternal dehiscence // Ann. Thorac. Surg. – 2008. – Vol. 85(6). – P. 2164–2165.
49. Sarэkaya S., Aksoy E., Ozen Y. et al. Thermoreactive nitinol clips: propensity score comparison with Robicsek technique // Asian Cardiovasc. Thorac. Ann. – 2014. – Vol. 23(4). – P. 399–405.
50. Kim W.K., Kim J.B., Jung S.H. et al. Titanium plate fixation for a dehisced sternum following coronary artery bypass grafting: a case report // Korean J. Thorac. Cardiovasc. Surg. – 2012. – Vol. 45(2). – P. 127–130.
51. Sansone F., Mossetti C., Bruna M.C. et al. Transomental titanium plates for sternal osteomyelitis in cardiac surgery // J. Card. Surg. – 2011. – Vol. 26(6). – P. 600–603.
52. Motomatsu Y., Imasaka K., Tayama E. et al. Unexpected results after sternal reconstruction with plates, cables and cannulated screws // Interact. Cardiovasc. Thorac. Surg. – 2016 [Electronic resourse]. – pii: ivv402.
53. Franco S., Herrera A.M., Atehortua M. et al. Use of steel bands in sternotomy closure: implications in high risk cardiac surgical population // Interact. Cardiovasc. Thorac. Surg. – 2009. – Vol. 8(2). – P. 200–205.
Review
For citations:
Shvedova M.V., Anfinogenova Y., Dambaev G.Ts., Vusik A.N. APPROACHES TO STERNAL OSTEOSYNTHESIS IN POSTSTERNOTOMY COMPLICATIONS MANAGEMENT. Siberian Journal of Clinical and Experimental Medicine. 2016;31(3):26-32. (In Russ.) https://doi.org/10.29001/2073-8552-2016-31-3-26-32
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