Ann Thorac Surg 1995;60:1132
© 1995 The Society of Thoracic Surgeons
How To Do It
New Technique for Sternal Osteosynthesis
Daniel Roux, MD,
Gérard Fournial, MD,
Yves Glock, MD,
Rémy Nottin, MD
Département de Chirurgie Cardio-Vasculaire, Hôpital de Rangueil, Toulouse, France
Accepted for publication June 9, 1995.
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Abstract
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In our department, we have developed a new method for sternal osteosynthesis. This technique uses steel threads and a sternal retractor. The removable valves are removed and placed with a two-pulley device, which allows good osteosynthesis without assistance or effort.
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Introduction
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Good consolidation of sternotomy mainly depends on the quality of osteosynthesis, of which the two main characteristics are good matching of the sternotomy edges and compression setting. The usual techniques do not permit an easy osteosynthesis, especially in obese patients or patients who underwent procurement of one or two internal thoracic arteries, thus creating an anteroposterior space between the sternal edges.
In our department, we have developed a new method using the usual steel threads and sternal retractor (Fig 1
). The removable valves are removed and replaced with a two-pulley device, which allows good osteosynthesis without assistance or effort.
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Fig 1. . The retractor, values allowing one to retract the sternal edges, and device for joining sternal edges.
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Technique
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Usually we place six steel threads on the sternum, sometimes seven or eight in case of a fragile sternum or obese patient. The second and fifth steel threads are crossed and tied together so as to obtain a frame (Fig 2).
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Fig 2. . Threads 2 and 5 are crossed and tied up, then placed in the pulleys. Opening of the retractor permits one to join both sternal edges together.
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The retractor is placed so that the frame steel thread passes within the pulleys' grooves. Afterwards, the retractor is opened to obtain progressive joining of the sternal edges (see Fig 2
). The free hand allows one to place both sternal edges at the same level until there is compression. Then, threads 1, 3, 4, and 6 are tied up, after which the retractor can be removed and threads 2 and 5 tied up. Thanks to this technique, one person can easily perform good sternal osteosynthesis.
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Comment
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We have used this technique in more than 50 adult patients operated on for valvular replacement or coronary bypass grafting. In all cases, the consolidation of the sternal osteosynthesis was obtained without any problems. Scanner monitoring was also performed. In 3 cases a 3- to 4-mm space was observed between the sternal edges. However, consolidation was achieved without difficulty.
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Footnotes
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This instrument is patented and manufactured by and commercially available through Delacroix-Chevalier, Instruments de Chirurgie SA, 13 Ave de la République, 75011 Paris, France.
Address reprint reuests to Dr Roux, Departement de Chirurgie Cardio-Vasculaire, Hôpital Rangueil, 1 Ave Jean-Poulhès, 31054 Toulouse Cedex, France.
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References
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- Noyez L, Verkroost MW, Van Asten WN, Kaan GL, Lacquet LK. Sternal closure: comparaison of two techniques. Cardiovasc Surg 1993;1:643–5.[Medline]
- Gottlieb LJ, Pielet RW, Karp RB, Krieger LM, Smith DJ, Deeb CM. Rigid internal fixation of the sternum in post-operative mediastinitis. Arch Surg 1994;129:489–93.[Abstract/Free Full Text]
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Abstract
Introduction
