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• W2024528030 abstract "We describe a novel surgical technique with a median sternotomy closure in high-risk open heart patients. In contrast to conventional sternal closure, in which sternal wires are passed through the intercostal space, the novel technique in sternal closure passes sternal wires transcostally or through costo-chondral joints. We describe a novel surgical technique with a median sternotomy closure in high-risk open heart patients. In contrast to conventional sternal closure, in which sternal wires are passed through the intercostal space, the novel technique in sternal closure passes sternal wires transcostally or through costo-chondral joints. There are over 750,000 median sternotomies performed every year in the United States. The sternal dehiscence rate is reported between 0.5% and 8% [1Del Campo C. Heimbecker R.O. Repair of refractory sternal dehiscence: a new technique.J Thorac Cardiovasc Surg. 1982; 83: 937-938PubMed Google Scholar, 2Culliford A.T. Cunningham J.N. Zeff R.H. Isom O.W. Teiko P. Spencer F.C. Sternal and costochondral infections following open heart surgery: a review of 2,594 cases.J Thorac Cardiovasc Surg. 1976; 72: 714-726PubMed Google Scholar, 3Tavilla G. Van Son J.A.M. Verhagen A.F. Lacquet L.K. Modified Robicsek technique for complicated sternal closure.Ann Thorac Surg. 1991; 52: 1179-1180Abstract Full Text PDF PubMed Scopus (48) Google Scholar], and the mortality rate is between 10% and 40% [3Tavilla G. Van Son J.A.M. Verhagen A.F. Lacquet L.K. Modified Robicsek technique for complicated sternal closure.Ann Thorac Surg. 1991; 52: 1179-1180Abstract Full Text PDF PubMed Scopus (48) Google Scholar]. The sternal dehiscence rate is much higher in high-risk open heart patients, such as those who are greater than 75 years of age, morbidly obese with a body mass index > 30 kg/m2, and patients with a history of osteoporosis. A better median sternotomy closure technique will prevent unnecessary cost, morbidity, and mortality associated with sternal dehiscence. The vast majority of sternal dehiscences occur as a result of the sternal wires cutting through the sternum. A closure technique that minimizes the migration of sternal wires into the sternum should prevent sternal dehiscence. A conventional sternal closure involves eight or more stainless steel wires passed trans-sternally or peri-sternally (Fig 1). In patients with a high risk of sternal dehiscence, such as those who are older in age (>75 years), have a history of osteoporosis, and are morbidly obese (body mass index > 30) are particularly susceptible to sternal dehiscence. A technique that places stainless steel wires transcostally with wider support should prevent sternal wires from cutting through the bone and should reduce the rate of sternal dehiscence in high-risk patients. The transcostal sternal closure technique involves placing three interrupted no. 6 stainless steel wires in the manubrium, as in conventional sternal closure, but with five remaining interrupted no. 6 stainless steel wires that are placed through costo-chondral joints and around the sternum (Fig 2, Fig 3). The needle of the stainless steel wire should easily pass through the costo-chondral joint space without cutting through the sternum. The wires are crossed, tightened, and cut, as in a conventional closure. Many of the elderly patients have calcified costo-chondral joints that give extra support.Fig 3Intraoperative photograph shows transcostal sternal closure in an elderly morbidly obese patient.View Large Image Figure ViewerDownload (PPT) Transcostal closure maximizes the closure strength with greater sternal volume and greater resistance to fracture. It redistributes the dehiscence force (fracture force) to greater bone volume of the sternum. This method of closure is simple to perform and has no additional cost. It avoids troublesome bleeding encountered in a conventional closure method that passes wires through the intercostal space and occasionally cuts through intercostal vessels. Our experience with the transcostal sternal closure method is greater than 150 cases, and none of the closures have dehisced. Any cardiothoracic surgeon can perform this closure just as well as conventional closure. The main difference between the closure method is the location of the placement of sternal stainless steel wires. There are no significant potential hazards associated with this procedure, and there are no exclusion criteria. The procedure time should be shorter for the transcostal closure because it avoids the troublesome bleeding that occurs frequently with the conventional closure method. In conclusion, the transcostal sternal closure technique is useful and effective in high-risk open heart patients with an increased risk of sternal dehiscence, such as patients who are 75 years old or older, morbidly obese with a body mass index greater than 30 kg/m2, and who have a history of osteoporosis. Additional patient groups may benefit from transcostal sternal closure, such as those patients who have an anatomically narrow and thin sternum, and patients who had off-midline sternotomy that leaves one edge of the sternum much narrower than the other." @default.
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• W2024528030 title "Effective Median Sternotomy Closure in High-Risk Open Heart Patients" @default.
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• W2024528030 doi "https://doi.org/10.1016/j.athoracsur.2009.05.057" @default.
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