Sternal closure in patients with the high risk of sternal dehiscence
https://doi.org/10.24884/0042-4625-2021-180-4-46-50
Abstract
The objective was to evaluate the efficacy of sternal closure using the «double twist» technique.
Methods and materials. The study included 37 patients with risk factors for sternal dehiscence (obesity, diabetes, chronic obstructive pulmonary disease). The patients were divided into 2 groups. In the first group (n=12), «double twist» technique was used. In patients of the second group (n=25), osteosynthesis was performed using standard technique (single wire ligatures). The efficacy of the «double twist» sternal closure was evaluated on the basis of clinical examination and multispiral computed tomography of the chest.
Results. In the early postoperative period, the sternal dehiscence, which required re-operation was detected in 12 % after standard sternal closure. Sternum was stable in all of the patients of «double twist» group (p=0.211). No deep sternal infection was observed in both groups. In the follow-up (up to 6 months), there were no clinical and tomographic sings of delayed sternal dehiscence or infection in «double twist» group.
Conclusions. Sternal closure using the «double twist» technique provides reliable fixation of the sternum in patients with the risk of its dehiscence.
About the Authors
D. S. Panfilov
Tomsk National Research Medical Center of the Russian Academy of Sciences
Russian Federation
Russian Federation
Panfilov Dmitri S., Dr. of Sci. (Med.), Senior Research Fellow of the Department of Cardiovascular Surgery, Cardiology Research Institute
Tomsk
E. L. Sonduev
Tomsk National Research Medical Center of the Russian Academy of Sciences
Russian Federation
Russian Federation
Sonduev Erdeni L., Postgraduate Student of the Department
of Cardiovascular Surgery, Cardiology Research Institute
Tomsk
M. S. Kuznetsov
Tomsk National Research Medical Center of the Russian Academy of Sciences
Russian Federation
Russian Federation
Kuznetsov Mikhail S., Cand. of Sci. (Med.), Senior Research Fellow of the Department of Cardiovascular Surgery, Cardiology Research Institute
Tomsk
B. N. Kozlov
Tomsk National Research Medical Center of the Russian Academy of Sciences
Russian Federation
Russian Federation
Kozlov Boris N., Dr. of Sci. (Med.), Head of the Department of Cardiovascular Surgery, Cardiology Research Institut
Tomsk
References
1. Višniewski A. A., Rudakov S. S., Milanov N. O. Surgery of the chest wall. Мoscow, Vidar, 2005:143. (In Russ.).
2. Kozlov B. N., Kuznetsov M. S., Kazakov V. A., Shipulin V. M., Panfilov D. S., Baykov A. N., Oks E. M. The first pilot experiment of sternotomy with plasmatic knife // The Siberian Medical Journal. 2010;25(4–1):123–126. (In Russ.).
3. Bek E. L., Yun K. L., Kochamba G. S., Pfeffer T. A. Effective median sternotomy closure in high-risk open heart patients // The Annals of thoracic surgery. 2010;89(4):1317–1318. Doi: 10.1016/j.athoracsur.2009.05.057
4. Charchyan E. R., Stepanenko A. В., Gens A. Р., Skvortsov А. А., Galeev N. А. The effect of the sternal closure techniques on pain severity after cardiac surgery // Clin. Experiment. Surg. Petrovsky J. 2016;3(13):65–73. (In Russ.).
5. Spindler N., Lehmann S., Steinau H. U., Mohr F. W., Langer S. Complication management after interventions on thoracic organs: deep sternal wound infections // Der Chirurg; Zeitschrift fur alleGebiete der operative Medizen. 2015;86(3):228–233. Doi: 10.1007/s00104-0142833-8.
6. Dyuzhikov A. A., Kartashov A. A. Comparative efficacy of different sternum osteosynthesis techniques in obese patients with coronary heart disease after coronary artery bypass grafting // Russ J of Cardiology and Cardiovascular Surgery. 2013;6(5):38–41. (In Russ.).
7. Molina J. E., Lew R. S., Hyland K. J. Postoperative sternal dehiscence in obese patients: incidence and prevention // The Annals of thoracic surgery. 2004;78(3):912–917. Doi: 10.1016/j.athoracsur.2004.03.038.
8. Patent RF no. 2020109592. Method of sternum metallic osteosynthesis afrer median sternotomy in patients with high risk of sternum dehiscence / D. S. Panfilov, E. L. Sonduev, B. N. Kozlov, M. S. Kuznetsov. 2020. (In Russ.).
9. Cataneo D. C., Dos Reis T. A., Felisberto G., Rodrigues O. R., Cataneo A. J. New sternal closure methods versus the standard closure method: systematic review and meta-analysis // Interactive cardiovascular and thoracic surgery. 2019;28(3):432–440. Doi: 10.1093/icvts/ivy281.
10. Cohen C. O. L. D. J., Griffin L. V. A biomechanical comparison of three sternotomy closure techniques // The Annals of thoracic surgery. 2002; 73(2):563–568. Doi: 10.1016/s0003-4975(01)03389-6.
11. Tavlasoglu M., Kurkluoglu M., Arslan Z., Durukan A. B. Detachment and dislocation of thermoreactive clips from sternum in late postoperative period due to misuse // Interactive cardiovascular and thoracic surgery. 2012;14(4):491–493. Doi: 10.1093/icvts/ivr165.
12. Loladze G., Kuehnel R. U., Claus T., Hartrumpf M., Kuepper F., Pohl M., Albes J. M. Double-wire versus single-wire sternal closure in obese patients: A randomized prospective study // The Thoracic and cardiovascular surgeon. 2017;65(4):332–337. Doi: 10.1055 / s-0035-1544369.
Supplementary files
Review
For citations:
Panfilov D.S., Sonduev E.L., Kuznetsov M.S., Kozlov B.N. Sternal closure in patients with the high risk of sternal dehiscence. Grekov's Bulletin of Surgery. 2021;180(4):46-50. (In Russ.) https://doi.org/10.24884/0042-4625-2021-180-4-46-50
Views:
976
Email this article 