Arda Aybars PALA, Hasan İNER, Murat Abdulhamit ERCİŞLİ

Açık kalp cerrahisinde geleneksel yönteme alternatif sternum kapama tekniğimiz

Giriş: Açık kalp cerrahisinde postoperatif süreçte görülen nadir fakat ciddi bir komplikasyon sternal dehisenstir. Sternal dehisensi önlemek için sternumun iyi kapatılması şarttır. Çelik tellerle sternumun birleştirilmesi konvansiyonel sternum kapama tekniği olarak kabul görmektedir. Biz bu çalışmada, kliniğimizde çelik teller ile uyguladığımız alternatif bir sternum kapama tekniğini ve sonuçlarını sunmayı amaçladık. Yöntem: Kliniğimizde Ocak 2017 ile Ocak 2018 tarihleri arasında açık kalp cerrahisi uygulanmış 115 hastanın verileri retrospektif olarak değerlendirildi. Hastaların hepsinin sternum kapatılması uyguladığımız alternatif teknik ile yapıldı. Hastaların sternal dehisens için risk faktörleri ve postoperatif verileri değerlendirildi. Bulgular: Postoperatif süreçte %4.3 oranında yüzeysel sternal yara yeri enfeksiyonu gelişti. Hiçbir hastada derin sternal enfeksiyon (mediastinit) ve sternal dehisens gelişmedi. Dört hastada sternal komplikasyona bağlı olmayan mortalite görüldü. 106 hastada (%92.1) sorunsuz olarak sternum stabilitesi ve primer yara iyileşmesi sağlandı. Sonuç: Uyguladığımız sternum kapama tekniğinin sternal komplikasyonları önlemede etkin ve kolay uygulanabilir bir teknik olduğu düşüncesindeyiz.

Anahtar Kelimeler:

açık kalp cerrahisi, sternal dehisens, sternum kapama

Alternative sternum closure technique to traditional method in open heart surgery

Objectives: Sternal dehiscence is a rare but serious complication seen in postoperative period in cardiac surgery. A good closure of the sternum is essential to prevent sternal dehiscence. Closure of sternum by steel wires is accepted as conventional sternal closure technique. In this study, we aimed to present an alternative sternal closure technique and its results with steel wires in our clinic.Methods: The data of 115 patients who underwent open heart surgery between January 2017 and January 2018 in our clinic were evaluated retrospectively. Sternal closure of all patients was performed with our alternative technique. Risk factors for sternal dehiscence and postoperative data of patients were evaluated.Results: In the postoperative period, superficial sternal wound infection occurred at a rate of 4.3%. None of the patients developed deep sternal infection (mediastinitis) and sternal dehiscence. Four patients had mortality and were not related to sternal complications. Sternal stability and primary wound healing were achieved in 106 patients (92.1%) without any problem. Conclusion: We think that our sternal closure technique is an effective and easily applicable technique to prevent sternal complications.

Keywords:

open heart surgery, sternal dehiscence, sternal closure,

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