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sternal dehiscence

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https://www.readbyqxmd.com/read/29303867/a-new-device-for-securing-sternal-wires-after-median-sternotomy-biomechanical-study-and-retrospective-clinical-assessment
#1
Matthew R Danter, Amy Saari, Min Gao, Anson Cheung, Samuel V Lichtenstein, James G Abel
OBJECTIVE: Morbidity due to sternotomy continues to be a significant clinical problem. Poor approximation of the sternum may lead to complications such as sternal dehiscence, infection, and pain. A device to assist in tensioning and twisting standard steel wires during sternal closure has been developed (TORQ sternal closure device). Manually tightened interrupted wire closures were compared with those tightened and secured with the aid of the device. Performance of the device was assessed clinically...
January 4, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/29223418/should-diabetes-be-a-contraindication-to-bilateral-internal-mammary-artery-grafting
#2
Alexander Iribarne, Benjamin M Westbrook, David J Malenka, Joseph D Schmoker, Jock N McCullough, Bruce J Leavitt, Paul W Weldner, Joseph DeSimone, Robert S Kramer, Reed D Quinn, Elaine M Olmstead, John D Klemperer, Gerald L Sardella, Cathy S Ross, Anthony W DiScipio
BACKGROUND: This study evaluates the influence of bilateral internal mammary artery (BIMA) versus single internal mammary artery (SIMA) grafting on postoperative morbidity and long-term survival among diabetic patients undergoing coronary artery bypass grafting (CABG). METHODS: A multicenter, retrospective analysis of 47,984 consecutive CABGs performed from 1992 to 2014 at 7 medical centers was conducted. Among the study population, 1,482 CABGs with BIMA were identified, and 1,297 BIMA patients were propensity-matched to 1,297 SIMA patients...
December 6, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29211217/application-of-unilateral-pectoralis-major-muscle-flap-in-the-treatment-of-sternal-wound-dehiscence
#3
Grazielle de Souza Horácio, Pedro Soler Coltro, Antonio Albacete, Juliano Baron Almeida, Vinícius Zolezi da Silva, Ivan de Rezende Almeida, Alfredo José Rodrigues, Jayme Adriano Farina
OBJECTIVE: This study aims to report the use of the unilateral pectoralis major muscle flap for the treatment of the sternal wound dehiscence. METHODS: A retrospective study including patients who underwent unilateral pectoralis major muscle flap was performed for the treatment of sternotomy dehiscence due to coronary artery bypass, valve replacement, congenital heart disease correction and mediastinitis, between 1997 and 2016. Data from the epidemiological profile of patients, length of hospital stay, postoperative complications and mortality rate were obtained...
September 2017: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/29171159/unilateral-pectoralis-major-muscle-flap-for-the-treatment-of-sternal-wounds-due-to-ludwig-s-angina
#4
Antonio Albacete Neto, Pedro S Coltro, Grazielle S Horácio, Ivan R Almeida, Jayme A Farina Junior
Necrotising descending mediastinitis may rarely originate from Ludwig's angina, which is an infection of the submandibular space. The use of the bilateral pectoralis major muscle flap for the treatment of sternal wound dehiscence is common, but reports of the unilateral application of this flap are scarce. This study aims to report the use of the unilateral pectoralis major muscle flap for the treatment of sternotomy dehiscence in a patient with mediastinitis due to Ludwig's angina. A 21-year-old male patient underwent an exploratory cervicotomy and median sternotomy for drainage of a submandibular infection that extended to the anterior, retropharyngeal and mediastinal cervical spaces...
November 24, 2017: International Wound Journal
https://www.readbyqxmd.com/read/29153509/transcatheter-embolization-of-a-giant-coronary-artery-pseudoaneurysm
#5
Pratik Dalal, Divyashree Varma, Ripa Chakravorty, Salil Sethi, Steven Bailey, Anand Prasad
A 53-year-old diabetic male with sternal dehiscence presented with recurrent staphylococcus bacteremia 2years after coronary artery bypass grafting (CABG). He was found to have a giant right coronary artery (RCA) pseudoaneurysm and a coronary cameral fistula on imaging. Due to excessive surgical risk, the patient underwent percutaneous treatment with a 5mm Amplatzer vascular plug 4 (St. Jude Medical, St.Paul, MN). Post-procedure imaging showed successful cessation of flow into the pseudoaneurysm and follow-up CT scan demonstrated significant improvement in the size of the pseudoaneurysm...
November 16, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/29096673/sternal-reconstruction-after-post-sternotomy-mediastinitis
#6
REVIEW
Pankaj Kaul
BACKGROUND: Deep sternal wound complications are uncommon after cardiac surgery. They comprise sternal dehiscence, deep sternal wound infections and mediastinitis, which will be treated as varying expressions of a singular pathology for reasons explained in the text. METHODOLOGY AND REVIEW: This article reviews the definition, prevalence, risk factors, prevention, diagnosis, microbiology and management of deep sternal wound infections and mediastinitis after cardiac surgery...
November 2, 2017: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28883736/omentum-flap-as-a-salvage-procedure-in-deep-sternal-wound-infection
#7
Nick Spindler, Christian D Etz, Martin Misfeld, Christoph Josten, Friedrich-Wilhelm Mohr, Stefan Langer
INTRODUCTION: Deep sternal wound infections (DSWIs) are rare but devastating complication after median sternotomy following cardiac surgery. Especially in the presence of artificial material or inadequate preliminary muscle flaps, the pedicled omentum flap is due to its immunological properties, the predetermined flap in salvage procedures. METHODS: We treated 14 patients suffering a mediastinitis and open thorax using a pedicled omentoplasty as a salvage procedure because of persisting DSWIs...
2017: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/28740625/pulmonary-valve-replacement-in-patients-with-corrected-tetralogy-of-fallot
#8
Fotios M Mitropoulos, Meletios A Kanakis, Christos Ntellos, Constantinos Loukas, Periklis Davlouros, Theophili Kousi, Andrew C Chatzis
Introduction: Development of pulmonary insufficiency in patients with surgically corrected tetralogy of Fallot (TOF) may lead to severe right heart failure with serious consequences. We herein present our experience with pulmonary valve replacement (PVR) in these patients. Methods: From 2005-2013, 99 consecutive patients (71 males/28 females, mean age 38±8 years), underwent PVR after 7 to 40 (mean 29 ± 8) years from the initial correction. Seventy nine of the symptomatic patients presented in NYHA II, 14 in III and 2 in IV...
2017: Journal of Cardiovascular and Thoracic Research
https://www.readbyqxmd.com/read/28460201/deep-sternal-wound-infections-a-severe-complication-after-cardiac-surgery
#9
A Morgante, F Romeo
Sternal Wound Infections (SWI) represent a dangerous complication after cardiac surgery entailing significantly longer hospital stays and worse short-term survival, especially in case of deep infections (DSWI) with the onset of osteomielitis or mediastinitis. The real incidence of SWI can be estimated between 0.25% and 10%; among the risk factors for sternal dehiscences after a longitudinal median sternotomy, several experiences underline the role of diabetes as an independent risk factor for post-operative infections, especially in patients affected by COPD with higher BMI...
January 2017: Il Giornale di Chirurgia
https://www.readbyqxmd.com/read/28345371/ewma-document-negative-pressure-wound-therapy
#10
Jan Apelqvist, Christian Willy, Ann-Mari Fagerdahl, Marco Fraccalvieri, Malin Malmsjö, Alberto Piaggesi, Astrid Probst, Peter Vowden
1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care.(1) NPWT has been described as a effective treatment for wounds of many different aetiologies(2,3) and suggested as a gold standard for treatment of wounds such as open abdominal wounds,(4-6) dehisced sternal wounds following cardiac surgery(7,8) and as a valuable agent in complex non-healing wounds...
March 1, 2017: Journal of Wound Care
https://www.readbyqxmd.com/read/28274522/preoperative-glycosylated-hemoglobin-a-risk-factor-for-patients-undergoing-coronary-artery-bypass
#11
Pradeep Narayan, Sarang Naresh Kshirsagar, Chandan Kumar Mandal, Paramita Auddya Ghorai, Yashaskar Manjunatha Rao, Debasis Das, Atanu Saha, Saibal Roy Chowdhury, Emmanuel Rupert, Mrinalendu Das
BACKGROUND: The prevalence of diabetes in the population of patients presenting with coronary artery disease continues to rise. The aim of this study was to assess whether high Glycosylated hemoglobin (HbA1c) was associated with adverse outcomes in patients undergoing elective coronary artery bypass grafting. METHODS: A retrospective observational study on prospectively collected data in 4,678 patients undergoing elective, isolated coronary artery bypass graft procedures in a single institution over a 4-year period was conducted...
August 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28216828/the-extended-myocutaneous-pectoralis-major-flap-a-new-tool-for-the-successful-coverage-of-the-lower-third-in-sternal-dehiscence
#12
Eduardo Simón-Sanz, Enrique Salmerón-González, Eloisa Villaverde-Domenech, Alberto Pérez-García, Alberto Ruiz-Cases
No abstract text is available yet for this article.
September 2016: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
https://www.readbyqxmd.com/read/28070049/-common-factors-for-ischemic-cerebral-stroke-in-coronary-artery-bypass-grafting-in-patients-with-concomitant-carotid-and-coronary-artery-severe-stenosis
#13
Lei Huang, Feng Kuang, Zhonggui Shan, Yiquan Lai, Hongwei Guo
To analyze two common factors for perioperative ischemic stroke in patients with concomitant carotid and coronary artery severe stenosis and to improve the therapeutic effect.
 Methods: A total of 44 patients with multi-vessel coronary artery disease combined with carotid stenosis, who admitted to the Department of Cardiac Surgery, the First Affiliated Hospital of Xiamen University from 2008 to 2014, were enrolled in this study. Among them, 32 cases were male, 12 cases was female. All patients received coronary artery bypass grafting after treatment of neck diseases...
December 28, 2016: Zhong Nan da Xue Xue Bao. Yi Xue Ban, Journal of Central South University. Medical Sciences
https://www.readbyqxmd.com/read/27995554/a-randomized-trial-to-assess-the-contribution-of-a-novel-thorax-support-vest-corset-in-preventing-mechanical-complications-of-median-sternotomy
#14
Philippe P Caimmi, Maurizio Sabbatini, Emmanouil I Kapetanakis, Silvia Cantone, Marcus V Ferraz, Mario Cannas, Ugo F Tesler
OBJECTIVES: Mechanical complications of median sternotomy may cause significant morbidity and mortality in cardiac surgical patients. This study was aimed at assessing the role of Posthorax support vest (Epple, Inc., Vienna, Austria) in the prevention of sternal complications and the improvement of anatomical healing in patients at high risk for mechanical sternal dehiscence after cardiac surgery by mean of median sternotomy. METHODS: A prospective, randomized, study was performed and 310 patients with predisposing factors for sternal dehiscence after sternotomy for cardiac surgery were included...
June 2017: Cardiology and Therapy
https://www.readbyqxmd.com/read/27922523/a-simple-and-effective-technique-for-anatomical-approximation-of-the-upper-pericardium-using-hemostatic-clips
#15
Mubassher Husain, Metesh Nalin Acharya, Ian Cummings, Shahzad Gull Raja
Closure of the pericardium is important to protect bypass grafts, the great vessels, and the heart from injury due to sternal dehiscence. Furthermore, it is reported to reduce the formation of pericardial adhesions and thus facilitate entry into the chest at resternotomy. We here describe a simple, reproducible, and effective technique for tension-free approximation of the upper pericardium by applying small hemostatic clips to the preserved thymic fascia overlying the pericardium.
November 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27909272/-novel-sternum-closure-technique-using-ultra-high-molecular-weight-polyethylene-sutures
#16
Takashi Ando, Daichi Akiyama, Hiroshi Okada, Hiroshi Furukawa, Makoto Takeda
During cardiac surgery through midline sternotomy, sternum closure metal wires are usually used for. However, metal wires may damage the sternum and cause artifacts on X-ray. Therefore, we use a novel sternum closure technique in which metal wire is replaced by ultra-high molecular weight polyethylene(UHMWP) sutures. We have used this technique for 89 patients in 2014 and reviewed our experience. UHMWPs are often used for bone fracture cerclage, particularly in the vertebral body. UHMWPs may avoid sternal "cheese-cut" dehiscence...
December 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/27825689/safety-and-effectiveness-of-cadaveric-allograft-sternochondral-replacement-after-sternectomy-a-new-tool-for-the-reconstruction-of-anterior-chest-wall
#17
Giuseppe Marulli, Andrea Dell'amore, Francesca Calabrese, Marco Schiavon, Niccolò Daddi, Giampiero Dolci, Franco Stella, Federico Rea
BACKGROUND: Surgical excision with wide margins, prevention of respiratory impairment, and protection of surrounding organs are primary goals in resection and reconstruction of the chest wall. We describe our experience of the use of cadaveric cryopreserved sternal allograft. METHODS: Eighteen patients underwent surgery. Indications for sternectomy were sternal metastases (n = 9), primary chondrosarcoma (n = 4), sternal dehiscence (n = 2), soft tissue sarcoma (n = 1), malignant solitary fibrous tumor (n = 1), and direct involvement of thymic carcinoma (n = 1)...
March 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27740952/rigid-sternal-fixation-versus-modified-wire-technique-for-poststernotomy-closures-a-retrospective-cost-analysis
#18
Jiwon Sarah Park, Jennifer H Kuo, J Nilas Young, Michael S Wong
BACKGROUND: Rigid sternal fixation (RSF) has been shown to reduce sternal wound complications in high-risk patients. However, the higher initial cost continues to deter its use. This study evaluates the cost of caring for high-risk sternotomy patients who underwent RSF compared with those who underwent sternal closure with a modified wire technique (MWT). METHODS: A retrospective single institution review of high-risk patients who underwent MWT (n = 45) and RSF (n = 30) for primary sternal closure from 2006 to 2009 was conducted...
May 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/27733997/pectoralis-muscle-flap-repair-reduces-paradoxical-motion-of-the-chest-wall-in-complex-sternal-wound-dehiscence
#19
Jacob Zeitani, Marco Russo, Eugenio Pompeo, Gian Luigi Sergiacomi, Luigi Chiariello
BACKGROUND: The aim of the study was to test the hypothesis that in patients with chronic complex sternum dehiscence, the use of muscle flap repair minimizes the occurrence of paradoxical motion of the chest wall (CWPM) when compared to sternal rewiring, eventually leading to better respiratory function and clinical outcomes during follow-up. METHODS: In a propensity score matching analysis, out of 94 patients who underwent sternal reconstruction, 20 patients were selected: 10 patients underwent sternal reconstruction with bilateral pectoralis muscle flaps (group 1) and 10 underwent sternal rewiring (group 2)...
October 2016: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27720371/delayed-sternal-closure-in-infant-heart-surgery-the-importance-of-where-and-when-an-analysis-of-the-sts-congenital-heart-surgery-database
#20
MULTICENTER STUDY
Kristen Nelson-McMillan, Christoph P Hornik, Xia He, Luca A Vricella, Jeffrey P Jacobs, Kevin D Hill, Sara K Pasquali, Diane E Alejo, Duke E Cameron, Marshall L Jacobs
BACKGROUND: Delayed sternal closure (DSC) is commonly used to optimize hemodynamic stability after neonatal and infant heart surgery. We hypothesized that duration of sternum left open (SLO) was associated with rate of infection complications, and that location of sternal closure may mitigate infection risk. METHODS: Infants (age ≤365 days) undergoing index operations with cardiopulmonary bypass and DSC at STS Congenital Heart Surgery Database centers (from 2007 to 2013) with adequate data quality were included...
November 2016: Annals of Thoracic Surgery
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