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sternal dehiscence

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...
October 6, 2016: Annals of Plastic Surgery
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
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...
October 6, 2016: Annals of Thoracic Surgery
C Y Xu, D G Feng, J X Wang, Z Y Cheng, F Wang, B Lin, Z L Xie, L N Suo, P Du
Objective: To explore the application of new chest holder in the median sternotomy for open heart surgery in adults. Methods: Two hundred adult patients in Henan Provincial People's Hospital from May 2013 to May 2015 were enrolled in the study and randomly divided into two groups. Experimental group included 100 cases who accepted the new type of chest holder in the open heart surgery. Control group were also composed of 100 cases whose sternums were fixed with the pure steel wire cerclage. Sternal closure time was recorded since the sternum closing...
September 13, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Vita Boyar
BACKGROUND: Wound healing is a dynamic process that normally follows a predictable cascade of events. A common cause of delayed wound healing or wound dehiscence is increased colonization with microbes, often leading to infection. Infection may impede the healing process by inducing an undesirable inflammatory response. Systemic antibiotics and topical antiseptics are mainstays of treatment, but their adverse side effects and the potential for emergence of resistant microbial strains have led to a search for alternative approaches for control of bioburden...
September 2016: Journal of Wound, Ostomy, and Continence Nursing
Jacek Piątek, Anna Kędziora, Janusz Konstanty-Kalandyk, Grzegorz Kiełbasa, Marta Olszewska, Karol Wierzbicki, Irena Milaniak, Bryan HyoChan Song, Bogusław Kapelak, Tomasz Darocha
BACKGROUND: Coronary artery disease (CAD) is a major cause of death and disability in developed countries. Despite the fact that prevalence accrues with age, an increasing number of young patients suffering from CAD is being observed worldwide. The aim of this study is to describe the population of young adults suffering from CAD and requiring coronary artery bypass grafting (CABG), and to assess early outcomes after the procedure. METHODS: A retrospective cohort study analyzed 190 consecutive patients aged ≤50 years old that underwent CABG between 2010 and 2014...
2016: Heart Surgery Forum
Conor F Hynes, Omid Fatemi, Aditya C Sharma, Christian D Nagy, Gregory D Trachiotis
We present a complex case of a transapical redo mitral valve-in-valve replacement. Repeat mitral valve replacement was indicated for severe symptomatic bioprosthetic stenosis. In addition to the patient's numerous comorbidities that included diabetes, hepatic cirrhosis, ischemic cardiomyopathy, and atrial flutter, he had undergone a previous open mitral valve replacement that was complicated by sternal dehiscence requiring extensive chest wall reconstruction. Transapical approach was performed through left minithoracotomy incision with balloon-expandable valve...
May 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Kashyap Komarraju Tadisina, Richard L Drake, James E Zins, Raffi Gurunluoglu
Internal mammary artery perforator (IMAP)-based fasciocutaneous flaps have recently gained popularity in sternal wound reconstruction due to their decreased donor site morbidity. However, patients with significant macromastia or who are obese present a challenge when using these flaps due to their anatomy and associated comorbid conditions. Despite the prevalence of this population, there is a relative paucity of data on the use of local fasciocutaneous flaps and techniques to close sternotomy wounds in the obese population with hypertrophic or ptotic breasts...
August 2, 2016: Annals of Plastic Surgery
Sanne Molenkamp, Tjalling W Waterbolk, Massimo A Mariani, Paul M N Werker
OBJECTIVES: Mediastinitis and sternum dehiscence are serious complications after open heart surgery, causing an increase in hospital stay, utilization of health care resources, and mortality. The defect that results after sternal wound debridement frequently necessitates tissue-flap coverage, for which pectoralis major transposition currently is the preferred method. In this study, the postoperative outcome and individual characteristics of patients undergoing pectoralis major transposition were analyzed to identify predictors of complications after wound closure...
July 6, 2016: Annals of Plastic Surgery
H Suzuki, T Watanabe, T Okazaki, H Notsuda, H Niikawa, Y Matsuda, M Noda, A Sakurada, Y Hoshikawa, T Aizawa, T Miura, Y Okada
Clamshell incision is a standard approach for bilateral lung transplantation, providing a good operative field; however, once wide dehiscence occurs, its management is sometimes difficult because of intense immunosuppression and malnutrition of the recipient. A 22-year-old man with idiopathic pulmonary arterial hypertension underwent cadaveric bilateral lung transplantation through a clamshell incision using standard cardiopulmonary bypass. He developed wound dehiscence on postoperative day (POD) 20 that resulted in exposure of the bilateral fifth ribs and open pneumothorax...
April 2016: Transplantation Proceedings
Roemer J Vos, Lisa Jongbloed, Uday Sonker, Geoffrey T L Kloppenburg
Background Postoperative sternal dehiscence with or without mediastinitis is a complication of cardiac surgery leading to considerable disability. Titanium plate fixation can provide sternal stability in patients with a dehiscent sternum. The aim of this study is to compare clinical outcomes of titanium plate fixation with conventional treatment methods such as steel wire cerclage and pectoralis muscle reconstruction. Patients and Methods A retrospective analysis was performed on 42 patients who underwent sternal refixation after dehiscence or secondary wound closure after poststernotomy mediastinitis...
May 13, 2016: Thoracic and Cardiovascular Surgeon
Angela De Palma, Francesco Sollitto, Domenico Loizzi, Francesco Di Gennaro, Daniele Scarascia, Annalisa Carlucci, Giuseppe Giudice, Andrea Armenio, Rossana Ludovico, Michele Loizzi
BACKGROUND: We report short and long-term results with the dedicated Synthes(®) titanium plates system, introduced 5 years ago, for chest wall stabilization and reconstruction. METHODS: We retrospectively analyzed (January 2010 to December 2014) 27 consecutive patients (22 males, 5 females; range 16-83 years, median age 60 years), treated with this system: primary [3] and secondary [8] chest wall tumor; flail chest [5]; multiple ribs fractures [5]; sternal dehiscence-diastasis [3]; sternal fracture [1]; sternoclavicular joint dislocation [1]; Poland syndrome [1]...
March 2016: Journal of Thoracic Disease
V Sreenath Seenu Reddy
BACKGROUND: In patients with major comorbidities undergoing complex cardiothoracic surgery, incision management is critical. This retrospective review evaluated negative pressure over closed sternal incisions in cardiac patients with multiple comorbidities within 30 days post-median sternotomy. METHODS: Records of post-sternotomy patients treated with Prevena™ Incision Management System (KCI, an Acelity company, San Antonio, TX), a closed incision negative pressure therapy (ciNPT), were reviewed from September 2010 through September 2014...
2016: Curēus
Ruben Y Kannan
OBJECTIVE: To determine the feasibility of using the internal mammary artery perforator (IMAP) flap for superficial and deep sternal wound breakdowns. METHODS: This was a retrospective case review of 9 patients with sternal wound dehiscence over an 18-month period between 2013 and 2015. Seven of the 9 patients received a single IMAP flap to cover full-length sternal wounds, including 4 with a fasciocutaneous flap and 3 with a musculocutaneous flap. RESULTS: All of the patients were male, with a mean age of 68 years...
July 2016: Journal of Thoracic and Cardiovascular Surgery
Stephanie Grabert, Magdalena Erlebach, Albrecht Will, Rüdiger Lange, Bernhard Voss
OBJECTIVES: During the last decade, various plate fixation systems have been developed for the treatment of complicated sternal dehiscence after open-heart surgery. One of them is the Modular Sternal Cable System© (MSCS), which promises optimal distribution of forces along the whole sternum by using plates, cannulated screws and cables. However, in comparison with other systems, there is a lack of outcome data. METHODS: Sternal reconstruction with the MSCS was performed in 11 patients (male n = 10, age 72...
May 2016: Interactive Cardiovascular and Thoracic Surgery
Joseph Costa, Joshua R Sonett, Frank D'Ovidio
The bilateral transverse thoracosternotomy clamshell incision provides excellent exposure to the mediastinal structures in double lung transplantation. The use of a modified transverse sternotomy and a figure of 8 configuration with one monofilament metal wire, along with two longitudinal wires across the sternal division, results in greater stability and equally distributed oblique tension. Our described technique was more cost effective and resulted in no incidence of dehiscence. We present our experience using a modified transverse sternotomy and reinforced sternal closure method...
December 2015: Annals of Thoracic Surgery
Martin Kaláb, Jan Karkoška, Milan Kamínek, Eva Matějková, Zuzana Slaměníková, Aleš Klváček, Petr Šantavý
OBJECTIVES: Deep sternal wound infection poses a serious problem in cardiac surgery, with an up to 40% risk of mortality. Massive loss of sternum bone tissue and adjacent ribs results in major chest wall instability causing respiratory insufficiency and defects of soft tissue healing. Proposals for managing the situation have been published but the complexity of the issue precludes unequivocal resolution. Capitalizing on orthopaedic experience, we used allogeneic bone graft of sternum as a viable option...
March 2016: Interactive Cardiovascular and Thoracic Surgery
Babak Sharif-Kashani, Payman Shahabi, Mohammad-Hossein Mandegar, Leila Saliminejad, Behnood Bikdeli, Neda Behzadnia, Gholamreza Heydari, Hooman Sharifi, Savalan Aidanlou
BACKGROUND: The harmful effects of smoking on the postsurgical wound healing disturbances have been widely investigated across various surgical procedures. These effects after coronary artery bypass graft (CABG) surgery have been less explored. We aimed to investigate the association of smoking and the wound healing problems in post-CABG patients. MATERIALS AND METHODS: We compared the incidence of wound complications in 405 smokers and 405 nonsmokers who underwent an elective CABG surgery...
February 2016: Journal of Surgical Research
I-han Chiang, Shyi-Gen Chen, Chih-Hsin Wang
Deep sternal wound infections are potentially life-threatening complications after cardiac operations because they can spread into the mediastinum and cause postoperative morbidity and mortality. We present a 65-year-old man with a history of coronary artery bypass grafting. A large sternal defect was left after debridement. After brief vacuum-assisted closure (VAC), a free myocutaneous flap of the anterolateral thigh (ALT) was used to fill the dead space. At the 9-month follow-up, the wound had healed completely without tissue loss or complications, and the patient returned to normal life...
November 2015: Annals of Thoracic Surgery
Sandra Brunner, Claudius Diez, Bernhard Flörchinger, Philipp Kolat, Christof Schmid, Daniele Camboni
Objective The percentage of patients undergoing cardiac surgery under some sort of psychiatric medication (PM) is not negligible. Thus, this study aimed to evaluate a possible impact of preoperative PM on the outcome after cardiac surgery. Methods A matched case-control study was conducted by including all patients who underwent myocardial revascularization and/or surgical valve operation in our institution from December 2008 till February 2011 by chart review and institutional quality assurance database (QS) analysis...
October 30, 2015: Thoracic and Cardiovascular Surgeon
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