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The Annals of Thoracic Surgery, Vol 52, 490-494, Copyright © 1991 by The Society of Thoracic Surgeons
LA Sargent, AE Seyfer, J Hollinger, RM Hinson and GM Graeber
Although median sternotomy is used for most cardiac procedures,
postoperative dehiscence remains a serious and persistent problem. This
investigation was designed to assess new bone formation and sternal healing
across the linear osteotomy of the sternum and to determine if rigid
fixation would enhance bony healing and thus decrease unfavorable sequelae.
To test this hypothesis, 14 skeletally mature baboons (Papio anubis)
underwent standard median sternotomy; seven sternotomies were closed with
interrupted 24-gauge cerclage wires, and seven, with thin Vitallium
compression miniplates and transverse lag screws. The sterna from each
group were harvested en bloc at 4 and 8 weeks, radiographed, processed, and
serially sectioned and stained for histomorphometry to assess the quantity
of new bone across the linear osteotomy. Clinical stability was superior
with the plated and lag screw group at 4 weeks; however, by 8 weeks, no
clinical difference between treatments was apparent. Histomorphometric
analysis indicated that the linear osteotomy gap treated with plates and
screws was less than the gap associated with the wire group. Rigid fixation
of the sternum resulted in earlier union with primary osseous healing,
suggesting greater inherent stability. these factors may decrease adverse
sequelae for this procedure.
ARTICLES
The healing sternum: a comparison of osseous healing with wire versus rigid fixation
Plastic Surgery Service, Walter Reed Army Medical Center, Washington, DC.
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