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Ann Thorac Surg 2005;79:1352-1357
© 2005 The Society of Thoracic Surgeons

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Original articles: Cardiovascular

Sternal Nourishment in Various Conditions of Vascularization

The Department of Thoracic and Cardiovascular Surgery, Heineman Medical Research Laboratories, Carolinas Medical Center, Charlotte, North Carolina

Accepted for publication August 5, 2004.

^_* Address reprint requests to Dr Robicsek, Carolinas Medical Center, 1001 Blythe Blvd, Charlotte, NC28203 (E-mail: frobicsek{at}sanger-clinic.com).

Presented at the Poster Session of the Fifty-first Annual Meeting of the Southern Thoracic Surgical Association, Cancun, Mexico, Nov 4–6, 2004.

BACKGROUND: Early changes in sternal perfusion were studied after midline sternotomy and different methods of mammary artery (MA) harvesting.

METHODS: Our observations were made in the swine model after midline sternotomy. In group 1 (6 animals), after unilateral skeletonized MA harvesting, ^99mTc particles were injected intravenously. In group 2 (7 animals), after unilateral mammary artery and vein harvesting (semiskeletonized technique), ^99mTc particles were injected intravenously. In group 3 (5 animals), after skeletonized bilateral MA harvesting, ^99mTc particles were injected into the intercostal musculature lateral to the sternal border. In groups 1 to 3, sternal samples were analyzed using gamma counting. In group 4 (6 animals), unilateral skeletonized MA harvesting was performed. In group 5 (5 animals), the MA was harvested unilaterally using the semiskeletonized technique. In groups 4 and 5, sternal blood flow was assessed using thermography. Data were collected in all groups for 5 hours postoperatively.

RESULTS: Both radioactive and thermographic flow measurements showed a statistically significant decrease in sternal blood flow on the side of harvested mammary vessels, regardless of harvesting technique. Radioactivity of the devascularized hemisterni on the side of intramuscular particle injection was substantially higher than in the contralateral half, confirming the role of diffusion in sternal nourishment. The distal sternal segments were least perfused by the MA.

CONCLUSIONS: There is an acute reduction of sternal perfusion during the early postoperative period, even if collaterals are preserved by skeletonized MA harvesting. Diffusion plays an important role in sternal nourishment, particularly of the xiphoid, and even more so after MA harvesting.

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