ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Uday K. Dasika
James A. Magovern
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Dasika, U. K.
Right arrow Articles by Magovern, J. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Dasika, U. K.
Right arrow Articles by Magovern, J. A.
Related Collections
Right arrow Chest wall

Ann Thorac Surg 2003;75:1618-1621
© 2003 The Society of Thoracic Surgeons

Original article: general thoracic

Lower sternal reinforcement improves the stability of sternal closure

Uday K. Dasika, MDa, Dennis R. Trumble, MSa, James A. Magovern, MDa*

a Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA

Accepted for publication December 12, 2002.

* Address reprint requests to Dr Magovern, Department of Cardiothoracic Surgery, Allegheny General Hospital, 320 East North Ave, 14th St, Pittsburgh, PA15212, USA
e-mail: jmagover{at}wpahs.org

BACKGROUND: This study uses a mechanical testing system to evaluate three methods of sternal closure.

METHODS: Twelve sternal replicas composed of a polyurethane foam bone analogue were divided in the midline and reapproximated using three stainless steel wire techniques: six simple wires (6S), six figure-of-eight wires (6F8), or seven simple wires (7S), which included an extra wire at the lower sternum. The closures were subjected to increasing lateral distraction from 0 to 400 Newtons (N) (1 N = 0.224 lbs), and motion was measured using transducers stationed across the manubrium, midsternum, and lower sternum.

RESULTS: With each method of closure, the manubrium was the most stable, the lower sternum the least stable, and the midsternum intermediate between the other two. There were also differences between sternal closure methods, but only at the lower sternum. Less sternal distraction was measured with the 7S than the 6S and 6F8 methods, starting at 100 N (0.20 ± 0.06 mm vs 0.48 ± 0.19 and 0.39 ± 0.10, p = 0.003), and progressively increasing until the study was stopped at 400 N (1.64 ± 0.39 mm vs 4.92 ± 1.73 and 5.1 ± 1.43 mm, p = 0.003).

CONCLUSIONS: These data show that the lower sternum is the site of greatest instability and that reinforcement of this area with an additional wire effectively stabilizes the closure. Figure-of-eight wires are not superior to simple wires.




This article has been cited by other articles:


Home page
 Eur. J. Cardiothorac. Surg.Home page
L. C.H. John
Modified closure technique for reducing sternal dehiscence; a clinical and in vitro assessment
Eur. J. Cardiothorac. Surg., May 1, 2008; 33(5): 769 - 773.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. A. Magovern
Invited commentary
Ann. Thorac. Surg., April 1, 2007; 83(4): 1516 - 1517.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. E. Losanoff
Invited commentary.
Ann. Thorac. Surg., September 1, 2006; 82(3): 907 - 908.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. Pai, N. J. Gunja, E. L. Dupak, N. L. McMahon, T. P. Roth, J. F. Lalikos, R. M. Dunn, N. Francalancia, G. D. Pins, and K. L. Billiar
In Vitro Comparison of Wire and Plate Fixation for Midline Sternotomies
Ann. Thorac. Surg., September 1, 2005; 80(3): 962 - 968.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. E. Losanoff
Invited commentary
Ann. Thorac. Surg., September 1, 2005; 80(3): 968 - 968.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. E. Molina, R. S.-L. Lew, and K. J. Hyland
Postoperative sternal dehiscence in obese patients: Incidence and prevention
Ann. Thorac. Surg., September 1, 2004; 78(3): 912 - 917.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. E. Losanoff, B. W. Richman, and J. W. Jones
Lower sternal reinforcement to improve median sternotomy closure
Ann. Thorac. Surg., June 1, 2004; 77(6): 2261 - 2261.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
U. K. Dasika and J. A. Magovern
Lower sternal reinforcement to improve median sternotomy closure: Reply
Ann. Thorac. Surg., June 1, 2004; 77(6): 2261 - 2262.
[Full Text] [PDF]

Home page
 ICVTSHome page
N. Khasati, R. Sivaprakasam, and J. Dunning
Is the figure-of-eight superior to the simple wire technique for closure of the sternum?
Interactive CardioVascular and Thoracic Surgery, March 1, 2004; 3(1): 191 - 194.
[Abstract] [Full Text] [PDF]

Home page
 ICVTSHome page
L.-G. Dahlin, H. Granfeldt, and H. Hultkvist
A multimodal approach for reducing wound infections after sternotomy
Interactive CardioVascular and Thoracic Surgery, March 1, 2004; 3(1): 206 - 210.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2003 by The Society of Thoracic Surgeons.