Tamer TÜRK, Kadir Kaan ÖZSİN, Ufuk AYDIN, Orhan FINDIK, Ahmet Kağan AS, Yusuf ATA

Sternal cable wires for sternal closure in moderately or extremely obese patients undergoing cardiac surgery

Objectives: Sternal dehiscence is a frequent complication after cardiac surgery. Our study focused on theefficiency of a sternal cable system combined with conventional steel wires for sternal fixation in patientssuffering from moderate or extreme obesity and undergoing cardiac surgery.Methods: Prospectively collected data from 22 male and 41 female patients (a mean body mass index [BMI]of 37.9 ± 2.5 kg/m2) who underwent major cardiac surgery via median sternotomy and sternal closure using amultifilament sternal cable system were retrospectively reviewed and analyzed.Results:All patients were closed with a conjunction of two sternal cables and two traditional steel wires. Therewere two mortalities. There were no occurrences of sternal dehiscence or deep mediastinitis. Three patientssuffered superficial sternal wound infections. The mean hospitalization time was 8.4 ± 2.5 days.Conclusion: Our study showed that our surgical technique using a sternal cable system in combination withconventional wires decreased the incidence of sternal dehiscence in moderately and extremely obese patients.

PDF

___

Voss B, Bauernschmitt R, Will A, Krane M, Kröss R, Brockmann G, et al. Sternal reconstruction with titanium plates in complicated sternal dehiscence. Eur J Cardiothorac Surg 2008;34:139-45.
John LCH. Modified closure technique for reducing sternal dehiscence; a clinical and in vitro assessment. Eur J Cardiothorac Surg 2008;33:769-73.
El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg 1996;61:1030- 6.
Baskett RJ, MacDougall CE, Ross DB. Is mediastinitis apreventablecomplication? A 10-year review. Ann Thorac Surg 1999;67:462-5.
Bryan AJ, Lamarra M, Angelini GD, West RR, Breckenridge IM. Mediansternotomy wound dehiscence: a retrospective case control study of risk factors and outcome. J R Coll Surg Edinb 1992;37:305-8.
Molina JE, Lew RSL, Hyland KJ. Postoperative sternal dehiscence in obese patients: incidence and prevention. Ann Thorac Surg 2004;78:912-7.
Prabhakar G, Haan CK, Peterson ED, Coombs LP, Cruzzavala JL, Murray GF. The risks of moderate and extreme obesity for coronary artery bypass grafting outcomes: a study from the Society of Thoracic Surgeons’ database. Ann Thorac Surg 2002;74:1125-31.
National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. National Heart, Lung and Blood Institute. June 1998.
Schimmer C, Reents W, Berneder S, Eigel P, Sezer O, Scheld H, et al. Prevention of sternal dehiscence and infection in highrisk patients: a prospective randomized multicenter trial. Ann Thorac Surg 2008;86:1897-904.
Oh YN, Ha KJ, Kim JB, Jung SH, Choo SJ, Chung CH, et al. Multifilament cable wire versus conventional wire for sternal closure in patients undergoing major cardiac surgery. Korean J Thorac Cardiovasc Surg 2015;48:265-71.
Kiessling AH, Isgro F, Weisse U, Möltner A, Saggau W, Boldt J. Advanced sternal closure to prevent dehiscence in obese patients. Ann Thorac Surg 2005;80:1537-9.
Khasati N, Sivaprakasam R, Dunning J. Is the figure-of-eight superior to the simple wire technique for closure of the sternum? Interact Cardiovasc Thorac Surg 2004;3:191-4.
Grapow MT, Melly LF, Eckstein FS, Reuthebuch OT. A new cable-tie based sternal closure system: description of the device, technique of implantation and first clinical evaluation. J Cardiothorac Surg 2012;7:59.
Wangsgard C, Cohen DJ, Griffin LV. Fatigue testing of three peristernal median sternotomy closure techniques. J Cardiothorac Surg 2008;3:52.
Pioneer Surgical Technology Inc. Pioneer sternal cable system: cardiothoracic: cable system [Internet]. Marquette (MI): Pioneer Surgical Technology Inc.; c2015 [cited 2014 Dec 27]. Available from: http://www.pioneersurgical.com/cardiothoracic/Cable- System/Pioneer-Sternal-Cable-System/
Özen Y, Sarıkaya S, Rabuş MB, Günay D, Aksoy E, Dedemoğlu M, et al. Comparison of the sternal wires and sternal cable in closure of the sternum during cardiac surgery. Cardiovasc Surg Interven 2014;1:41-4.