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Ann Thorac Surg 2008;85:2164-2165. doi:10.1016/j.athoracsur.2007.12.014
© 2008 The Society of Thoracic Surgeons
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Vassilios S. Avlonitis
Vivek Shrivastava
John Wallis
Andrew Goodwin
Simon Kendall
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Correspondence

Thermoreactive Clips for Sternotomy Closure in Sternal Dehiscence

Vassilios S. Avlonitis, MD, PhD, Vivek Shrivastava, MRCS, John Wallis, FRCS, Steve Hunter, BMedSci, BM BS, Andrew Goodwin, FRCS (CTh), Andrew Owens, MD, FRCS, Simon Kendall, MBBS, FRCS (CTh)

Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom

(Email: avlonitis{at}hotmail.com).

To the Editor:

We have read with interest the article by Plass and colleagues [1] describing a plate fixation technique in 3 patients with sternal dehiscence. The authors state that the technique is simple because it does not require dissection behind the sternum; however, their technique requires raising extensive tissue flaps to expose the ribs. We have been using thermoreactive clips to close the sternum in patients with dehiscence. This is a simpler technique requiring less extensive surgery. The technique has been proven to reduce sternal dehiscence in a previous study [2].

The clips are made of nitinol. They allow 10% to 15% deformation in width during coughing or movement. Their contact surface with bone is five to seven times greater than steel wires, so they are less likely to break or cut through the sternum. The clips are thermoreactive, becoming malleable at low temperatures (<10°C) and returning to their original shape when the temperature increases. The memory effect begins at temperatures exceeding 27°C, and the definitive shape is retained at 35°C. Their thermoreactivity makes application easy and without trauma [2].

To apply the clips, 3 steel wires are applied on the sternum: 2 in the manubrium and 1 near the xiphoid. In patients with dehiscence, it is often possible to tighten the existing wires in the manubrium and lower end of the sternum. Then, electrocautery is used to create a groove in the intercostals spaces on either side of the sternal body. The distance across the sternum is measured for application of the correct clip size. The clips are cooled in ice water and mounted onto an applicator that splays them open. The clips are then applied around the sternum. On rewarming, the clips return to their original shape and strength, clasping the sternum together.

In our center, thermoreactive clips were used for sternotomy closure in 8 patients during reoperation for dehiscence after standard closure with steel wires at the first operation. The dehiscence was due to deep infection in 6 patients. They were all men with a mean age of 66.5 years, a mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 5.4, and a mean body mass index of 28.4. Closure was successful in all patients, and none required further surgery. Our experience with the use of thermoreactive clips in patients with sternal dehiscence suggests that this simple technique is highly effective in this group of patients.


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 References
 

  1. Plass A, Grunenfelder J, Reuthebuch O, et al. New transverse plate fixation system for complicated sternal wound infection after median sternotomy Ann Thorac Surg 2007;83:1210-1212.[Abstract/Free Full Text]
  2. Negri A, Manfredi J, Terrini A, et al. Prospective evaluation of a new sternal closure method with thermoreactive clips Eur J Cardiothorac Surg 2002;22:571-575.[Abstract/Free Full Text]

Related Article

Reply
Andre Plass, Jurg Grunenfelder, Ivo Guber, and Michele Genoni
Ann. Thorac. Surg. 2008 85: 2165. [Extract] [Full Text] [PDF]



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A. Plass, J. Grunenfelder, I. Guber, and M. Genoni
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Ann. Thorac. Surg., June 1, 2008; 85(6): 2165 - 2165.
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Vivek Shrivastava
John Wallis
Andrew Goodwin
Simon Kendall
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