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Ann Thorac Surg 1997;64:1226-1227
© 1997 The Society of Thoracic Surgeons

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Correspondence

Delayed Sternal Closure With Sternal Zipper

M. Murat Demirta, MD

Siyami Ersek Thoracic and Cardiovascular Surgery Center, Ihlamurdere Cad 149/5, Beikta, 80690, stanbul, Turkey

To the Editor:

Prolonged open sternum with delayed sternal closure is a worldwide accepted method of struggle against the hemodynamic instability related to cardiac compression, unstable cardiac rhythm, and unsatisfactory hemostasis with high risk of tamponade. It is also used as a mediastinal port for extracorporeal membrane oxygenation and other types of mechanical assistance.

Iyer and associates [1] mentioned various methods of delayed sternal closure with the use of a self-retaining retractor, mediastinal packing, silicone membrane or drape, and sternal stenting.

I would like to call attention here to another useful technique that we [2] and some other surgeons [3–5] apply: implantation of a sternal zipper. Under the circumstances stated above and by Iyer and coworkers, temporary closure of the cutaneous plane of the median sternotomy incision with a polyethylene zipper with or without mediastinal packing allows easy, repeated, and rapid access to the mediastinal cavity.

We have been using this technique in 85 patients beginning from July 1988 and the results of our first 50 cases were published in French in 1992 [2]. In this series, we had also 2 pediatric patients.

But in recent years, we had also many patients in whom the sternal wound was kept open but covered by a Steri-Drape (3M, Medical Surgical Division, St. Paul, MN) dressing. However these cases necessitate multiple exposures and the cost effectiveness of these methods must be evaluated for this group of patients with a very high hospital invoice.

References

1. Iyer RS, Jacobs JP, de Leval MR, Stark J, Elliott MJ. Outcomes after delayed sternal closure in pediatric heart operations: a 10-year experience. Ann Thorac Surg 1997;63:489–91.
2. Demirta M, Alhan C, Demiray E, Dasali S, Koryak M. Application du fermoir sternal au cours de la chirurgie à coeur ouvert. Arch Mal Coeur 1992;85:1011–4.
3. Applebaum RE, Green DC, Sequeira A, McLaughlin JS. Use of a zipper in cardiac surgical operations. Ann Thorac Surg 1987;43:227–8.
4. Gonzalez-Diego JF, Rico M, Duarte J, Fernandez-Caleya D, Garcia-Sabrido JL. Zipper sternotomy: a new approach to an old problem [Letter]. J Thorac Cardiovasc Surg 1988;96:671–2.
5. Mosimann E, Kiesler P, Leissing C, Schumuziger M. Fermeture différée du sternum après opération cardiaque. Helv Chir Acta 1990;57:249–53.

Reply

Department of Cardiothoracic Surgery, Sri Venkateshwara Institute of Medical Sciences, Tirupati 517507, India

To the Editor:

I read with interest the opinion of Dr Demirta from stanbul. The implantation of a sternal zipper [1] is no doubt a good method of delayed sternal closure while maintaining a closed sternal wound. But I believe that the closure of the skin using a silicone membrane [2] offers better visibility of the heart and lungs in addition to providing space in the mediastinum for the myocardial edema. In addition, it maintains a protective barrier from the atmosphere.

As to the fear of cost effectiveness expressed by Dr Demirta, I strongly believe that once we are committed to taking up a patient for operation, the main aim is to save the life, no matter what the cost incurred as that matter is secondary until newer measures and procedures are developed.

References

1. Demirta M, Alhan C, Demiray E, Dasali S, Koryak M. Application du fermoir sternal au cours de la chirurgie à coeur ouvert. Arch Mal Coeur 1992;85:1011–4.
2. Iyer RS, Jacobs JP, de Leval MR, Stark J, Elliott MJ. Outcomes after delayed sternal closure in pediatric heart operations: a 10-year experience. Ann Thorac Surg 1997;63:489–91.

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Demirtas, M. M. Articles by Iyer, R. Search for Related Content PubMed Articles by Demirtas, M. M. Articles by Iyer, R.