Ann Thorac Surg 2008;85:293. doi:10.1016/j.athoracsur.2007.09.027
© 2008 The Society of Thoracic Surgeons
Original Articles: General Thoracic
Invited commentary
William D. Spotnitz, MD, MBA
Surgical Therapeutic Advancement Center, PO Box 801370, University of Virginia Department of Surgery, Charlottesville, VA 22908-1370
It is important to remember that stability is one important factor, but not the only factor in the successful healing of median sternotomy wounds. Additional factors include an intact blood supply, absence of devitalized tissue, and a lack of infectious micro-organisms. Sternal stability is clearly an important factor so that repetitive sternal trauma from respiratory or other sources does not increase mobility and contribute to poor healing or infection, or both. However, the stability should not come at too high a price either literally or figuratively. The device should not be excessively costly (eg, the device costs approximately $410 to $475 at the time of this writing); the device should not take excessively long to install (ie, approximately 12 minutes for the device in addition to wire placement). The device also should not contribute to additional risks in one of the other areas of concern. It should not further restrict sternal blood supply, particularly in patients with unilateral or bilateral internal mammary artery grafts. The additional dissection necessary should not contribute to more devitalized tissues in the intercostal or sternal regions. Placement of the reinforcement device should not increase the risk of sternal contamination from glove puncture, prolongation of the operative procedure, or other sources.
The authors [1] are to be congratulated for testing a device that does seem to improve sternal closure stability by increasing the forces required for sternal disruption or displacement in both standard and faulty incisions, as well as a device that resists disruption on repetitive traction, such as that which might be caused by coughing or mechanical ventilation. The authors have also presented some preliminary clinical results in patients and have suggested that the device may be useful in high-risk patients. It remains to be seen if the device will avoid potential negative impacts on blood supply, devitalized tissues, and bacterial loads.
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References
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- Zeitani J, Penta de Peppo A, Bianco A, et al. Performance of a novel sternal synthesis device after median and faulty sternotomy: mechanical test and early clinical experience Ann Thorac Surg 2008;85:287-293.[Abstract/Free Full Text]
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Performance of a Novel Sternal Synthesis Device After Median and Faulty Sternotomy: Mechanical Test and Early Clinical Experience
- Jacob Zeitani, Alfonso Penta de Peppo, Alessandra Bianco, Francesca Nanni, Antonio Scafuri, Fabio Bertoldo, Alessandro Salvati, Saverio Nardella, and Luigi Chiariello
Ann. Thorac. Surg. 2008 85: 287-293.
[Abstract]
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