MyMedR

Alhalawani AM, Towler MR

J Biomater Appl, 2013 Nov;28(4):483-97.

PMID: 23812580 DOI: 10.1177/0885328213495426

Sternotomy and sternal closure occur prior to and post cardiac surgery, respectively. Although post-operative complications associated with poor sternal fixation can result in morbidity, mortality, and considerable resource utilization, sternotomy is preferred over other methods such as lateral thoracotomy. Rigid sternal fixation is associated with stability and reduced incidence of post-operative complications. This is a comprehensive review of the literature evaluating in vivo, in vitro, and clinical responses to applying commercial and experimental surgical tools for sternal fixation after median sternotomy. Wiring, interlocking, plate-screw, and cementation techniques have been examined for closure, but none have experienced widespread adoption. Although all techniques have their advantages, serious post-operative complications were associated with the use of wiring and/or plating techniques in high-risk patients. A fraction of studies have analyzed the use of sternal interlocking systems and only a single study analyzed the effect of using kryptonite cement with wires. Plating and interlocking techniques are superior to wiring in terms of stability and reduced rate of post-operative complications; however, further clinical studies and long-term follow-up are required. The ideal sternal closure should ensure stability, reduced rate of post-operative complications, and a short hospitalization period, alongside cost-effectiveness.

Matched MeSH terms: Sternum/surgery*

Fulltext Massive goiter with retrosternal extension encasing trachea and esophagus

Irfan M, Jihan WS, Shahid H

Med J Malaysia, 2010 Mar;65(1):85-6.

PMID: 21265261 MyJurnal

Massive goiter with retrosternal extension may impose additional risk such as difficult intubation, tracheomalacia, and possibility of different incision and approach including sternotomy. We would like to report a case of massive goiter encasing major neck structures and how it was managed.

Matched MeSH terms: Sternum/surgery

Comminuted sternal fracture -- a sternotomy wire fixation: report of 2 cases

Abdul-Rahman MR, Seong NK, Hee TG, Aljada ME, Reda TA, Sumin JO, et al.

Heart Surg Forum, 2009 Jun;12(3):E184-6.

PMID: 19546075 DOI: 10.1532/HSF98.20091016

Various techniques of sternal stabilization via either metal plates or wires have been described. We describe an alternative technique of simple median sternotomy followed by reduction and wire fixation of the sternal fracture. The 2 patients described in this report had traumatic comminuted and displaced sternal fractures. Even though wire repair was deemed to be tedious and achieved poor approximation of the bone, we performed median sternotomy and achieved simple wire fixation with an excellent result.

Matched MeSH terms: Sternum/surgery*

A randomized, placebo-controlled, double-blind, prospective clinical trial of silicone gel in prevention of hypertrophic scar development in median sternotomy wound

Chan KY, Lau CL, Adeeb SM, Somasundaram S, Nasir-Zahari M

Plast Reconstr Surg, 2005 Sep 15;116(4):1013-20; discussion 1021-2.

PMID: 16163087

BACKGROUND: Hypertrophic scarring caused by sternotomy is prevalent among Asians. The effectiveness of silicone gel in scar prevention may influence the decision of surgeons and patients regarding its routine use during the postoperative period.

METHODS: The authors conducted a randomized, placebo-controlled, double-blind, prospective clinical trial. The susceptibility to scar development varied among patients; therefore, sternal wounds were divided into the upper half and the lower half. Two types of coded gel prepared by an independent pharmacist were used on either half. Thus, selection and assessment biases and confounders were eliminated.

RESULTS: One hundred wounds in 50 patients were randomized into two arms, 50 control and 50 silicone gels. The median age was 61 years and there were 34 men and 16 women. Ethnic distribution was 28 Malays, 18 Chinese, and four Indians. No side effect caused by the silicone gel was noted. Ninety-eight percent of patients had moderate to good compliance. The incidence of sternotomy scar was 94 percent. At the third month postoperatively, the silicone gel wounds were scored lower when compared with the control wounds. The differences were statistically significant in all parameters, including pigmentation (p = 0.02), vascularity (p = 0.001), pliability (p = 0.001), height (p = 0.001), pain (p = 0.001), and itchiness (p = 0.02).

CONCLUSIONS: The effect of silicone gel in prevention of hypertrophic scar development in sternotomy wounds is promising. There are no side effects and patients' compliance is satisfactory. This study may popularize the use of silicone gel in all types of surgery to minimize the formation of hypertrophic scars in the early postoperative period.

Matched MeSH terms: Sternum/surgery*

Fulltext Thoracoplasty with acrylic plate-marlex mesh combination following near total resection of sternum: a case of chondrosarcoma of sternum

Premnath N, Lo HL, Cheong YT, Manjit S

Med J Malaysia, 2002 Sep;57(3):368-70.

PMID: 12440279

Removal of the whole sternum for malignant tumours results in a large defect, causing severe deformity and possible paradoxical movements of the chest wall. The reconstruction of the resultant large defect of the chest wall is often complex and difficult. Commonly used materials include rib autograft, steel strus acrylic plate and various synthetic meshes such as Goretex or Marlex mesh, with a myocutaneous flap for coverage. A case of a 48-year-old man with sternal chondrosarcoma successfully treated with thoracoplasty using acrylic plate-marlex mesh combination following near total resection of sternum is reported.

Matched MeSH terms: Sternum/surgery*

Fulltext Resection and reconstruction of malignant tumor involving sternum

Faisham WI, Ziyadi MG, Azman WS, Halim AS, Zulmi W, Biswal BM

Med J Malaysia, 2012 Apr;67(2):224-5.

PMID: 22822652 MyJurnal

We present a series of four cases of chest wall tumor, which underwent sternum resection. The methods of resection and reconstruction chest wall defect are discussed and the final outcome highlighted.

Matched MeSH terms: Sternum/surgery*

Fulltext Effect of sternal closure with biological bone adhesive on pain visual analogue score and serum cytokine

Hashim S, Chin LY, Krishnasamy S, Sthaneswar P, Raja Mokhtar RA

J Cardiothorac Surg, 2015;10:32.

PMID: 25890367 DOI: 10.1186/s13019-015-0230-0

Recently a biocompatible bone adhesive was introduced in addition to the sternal wires to expedite sternal union and improve patient recovery. In this study we aim to objectively assess the biomarker of pain in patient who received the biocompatible bone adhesive.

Matched MeSH terms: Sternum/surgery*

Dermacyn irrigation in reducing infection of a median sternotomy wound

Mohd AR, Ghani MK, Awang RR, Su Min JO, Dimon MZ

Heart Surg Forum, 2010 Aug;13(4):E228-32.

PMID: 20719724 DOI: 10.1532/HSF98.20091162

Sternal wound infection is an infrequent yet potentially devastating complication following sternotomy. Among the standard practices used as preventive measures are the use of prophylactic antibiotics and povidone-iodine as an irrigation agent. A new antiseptic agent, Dermacyn super-oxidized water (Oculus Innovative Sciences), has recently been used as a wound-irrigation agent before the closure of sternotomy wounds.

Matched MeSH terms: Sternum/surgery*

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