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Thorac Cardiovasc Surg 2000; 48(4): 1-8
DOI: 10.1055/s-2000-9945
Editorial
© Georg Thieme Verlag Stuttgart · New York

Sternal Instability After Midline Sternotomy

F. Robicsek, A. Fokin, J. Cook, D. Bhatia
  • Department of Cardiovascular and Thoracic Surgery and Heineman Medical Research Laboratory Carolinas Medical Center, Charlotte, North Carolina, USA
Further Information

Publication History

Publication Date:
31 December 2000 (online)

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The purpose of this paper is to discuss sternal instability a problem occasionally associated with midline sternotomy, including the etiology, predisposing conditions, diagnosis and management. Among the methods of repair, sternal weaving and pectoralis muscle advancement are thought to be especially effective.

Key words:

Sternal instability - Surgical treatment

References

  • 1 Milton A F. cited by Kirschner M. Tratada de technica operatoria general y especial.  Editorial Labor S A Barcelona.. 1944;  4 756-60
    PubMedGoogle Scholar
  • 2 Julian O C, Lopez-Belio M, Dye W S, Javid H, Grove W J. The median sternal incision in intracardiac surgery with extracorporeal circulation: a general evaluation of its use in heart surgery.  Surgery.. 1957;  21 172-3
    PubMedGoogle Scholar
  • 3 Cremer J, Gerber I, Mehler D, Haverich A. Wound infections after heart surgery interventions - a cost analysis.  Langenbecks Arch Chir Suppl Kongressbd.. 1997;  114 1356-7
    PubMedGoogle Scholar
  • 4 Cheng W, Cameron D E, Warden K E, Fonger J D, Gott V L. Biomechanical study of sternal closure techniques.  Ann Thorac Surg.. 1993;  55 737-40
    CrossrefPubMedGoogle Scholar
  • 5 Ozaki W, Buchman S R, Iannettoni M D, Frankenburg E P. Biomechanical study of sternal closure using rigid fixation techniques in human cadavers.  Ann Thorac Surg.. 1998;  65 1660-5
    CrossrefPubMedGoogle Scholar
  • 6 McGregor W E, Trumble D R, Magovern J A. Mechanical analysis of midline sternotomy wound closure.  J Thorac Cardiovasc Surg.. 1999;  117 1144-50
    CrossrefPubMedGoogle Scholar
  • 7 Hendrickson S C, Koger K E, Morea C J, Aponte R L, Smith P K, Levin L S. Sternal plating for the treatment of sternal nonunion.  Ann Thorac Surg.. 1996;  62 512-8
    CrossrefPubMedGoogle Scholar
  • 8 Okies J E, Phillips S J. Letter: Sternal approximation.  Ann Thorac Surg.. 1974;  17 423-5
    PubMedGoogle Scholar
  • 9 Bryan A J, Lamarra M, Angelini G D, West R R, Breckenridge I M. Median sternotomy wound dehiscence: a retrospective case control study of risk factors and outcome.  J R Coll Surg Edinb.. 1992;  37 305-8
    PubMedGoogle Scholar
  • 10 Serry C, Bleck P C, Javid H, Hunter J A, Goldin M D, DeLaria G A, Najafi H. Sternal wound complications. Management and results.  J Thorac Cardiovasc Surg.. 1980;  80 861-7
    PubMedGoogle Scholar
  • 11 Culliford A T, Cunningham J N Jr, Zeff R H, Isom O W, Teiko P, Spencer F C. Sternal and costochondral infections following open-heart surgery. A review of 2,594 cases.  J Thorac Cardiovasc Surg.. 1976;  72 714-26
    PubMedGoogle Scholar
  • 12 Shafir R, Weiss J, Herman O, Elami A. The danger in skin grafting the bare mediastinum after sternectomy for postcoronary bypass dehiscence.  Ann Thorac Surg.. 1989;  48 584-6
    PubMedGoogle Scholar
  • 13 Robicsek F, Masters T N, Littman L, Born G V. The embolization of bone wax from sternotomy incisions.  Ann Thorac Surg.. 1981;  31 357-9
    PubMedGoogle Scholar
  • 14 Robicsek F, Daugherty H K, Cook J W, Selle J G, Masters T N, O'Bar P R, Fernandez C R, Mauney C U, Calhoun D M. Mycobacterium fortuitum epidemics after open-heart surgery.  J Thorac Cardiovasc Surg.. 1978;  75 91-6
    PubMedGoogle Scholar
  • 15 Robicsek F, Hoffman P C, Masters T N, Daugherty H K, Cook J W, Selle J G, Mauney C U, Hinson P. Rapidly growing nontuberculous mycobacteria: a new enemy of the cardiac surgeon.  Ann Thorac Surg.. 1988;  46 703-10
    PubMedGoogle Scholar
  • 16 Watanabe G, Misaki T, Kotoh K. Microfibrillar collagen (Avitene) and antibiotic-containing fibrin-glue after median sternotomy.  J Card Surg.. 1997;  12 110-1
    PubMedGoogle Scholar
  • 17 Cooley D A. Personal communication with the author. 
    Google Scholar
  • 18 Yokoyama M, Wada J, Chino K, Ade W R. New wire suture for sternal fixation.  J Cardiovasc Surg (Torino).. 1988;  29 146-7
    PubMedGoogle Scholar
  • 19 Brantigan C O, Brown R K, Brantigan O C. The broken wire suture.  Am Surg.. 1979;  45 38-41
    PubMedGoogle Scholar
  • 20 Breyer R H, Mills S A, Hudspeth A S, Johnston F R, Cordell A R. A prospective study of sternal wound complications.  Ann Thorac Surg.. 1984;  37 412-6
    CrossrefPubMedGoogle Scholar
  • 21 Timmes J J, Wolvek S, Fernando M, Bas M, Rocko J. A new method of sternal approximation.  Ann Thorac Surg.. 1973;  15 544-6
    CrossrefPubMedGoogle Scholar
  • 22 Schultz R S, Boger J W, Dunn H K. Strength of stainless steel surgical wire in various fixation modes.  Clin Orthop.. 1985;  198 304-7
    PubMedGoogle Scholar
  • 23 Stoney W S, Alford W C Jr, Burrus G R, Frist R A, Thomas C S Jr. Median sternotomy dehiscence.  Ann Thorac Surg.. 1978;  26 421-6
    CrossrefPubMedGoogle Scholar
  • 24 LeVeen H L, Piccone V A. Nylon-band chest closure.  Arch Surg.. 1968;  96 36-9
    PubMedGoogle Scholar
  • 25 Sanfelippo P M, Danielson G K. Complications associated with median sternotomy.  J Thorac Cardiovasc Surg.. 1972;  63 419-23
    PubMedGoogle Scholar
  • 26 Badellino M, Cavarocchi N C, Kolff J, Alpern J B, McClurken J B. Sternotomy closure with Parham bands.  J Card Surg.. 1988;  3 235-6
    CrossrefPubMedGoogle Scholar
  • 27 Greve H, Clajus P, Dittrich H. Closure of median sternotomy with resorbable synthetic sutures.  Langenbecks Arch Chir.. 1986;  368 65-71
    PubMedGoogle Scholar
  • 28 Kreitmann B, Riberi A, Metras D. Evaluation of an absorbable suture for stemal closure in pediatric cardiac surgery.  J Card Surg.. 1992;  7 254-6
    PubMedGoogle Scholar
  • 29 Brown R P, Esmore D S, Lawson C. Improved sternal fixation in the transsternal bilateral thoracotomy incision.  J Thorac Cardiovasc Surg.. 1996;  112 137-41
    PubMedGoogle Scholar
  • 30 Vanleeuw P, Roux D, Fournial G, Dalous P, Glock Y, Puel P, Joffre F, Rousseau H. Early postoperative sternal approximation after ITA harvesting: computed tomographic evaluation.  Ann Thorac Surg.. 1991;  52 518-22
    PubMedGoogle Scholar
  • 31 Robicsek F, Daugherty H K, Cook J W. The prevention and treatment of sternum separation following open-heart surgery.  J Thorac Cardiovasc Surg.. 1977;  73 267-8
    CrossrefPubMedGoogle Scholar
  • 32 Robicsek F. Discussion of Article: Culliford AT, Cunningham JN Jr, Zeff RH, Isom OW, Teiko P, Spencer FC. Sternal and costochondral infections following open-heart surgery. A review of 2,594 cases.  J Thorac Cardiovasc Surg.. 1976;  72 714-26
    PubMedGoogle Scholar
  • 33 Copeland M, Senkowski C, Ulcickas M, Mendelson M, Griepp R B. Breast size as a risk factor for sternal wound complications following cardiac surgery.  Arch Surg.. 1994;  129 757-9
    PubMedGoogle Scholar
  • 34 De Fontaine S, Devos S, Goldschmidt D. Reduction mammaplasty combined with pectoralis major muscle flaps for median sternotomy wound closure.  Br J Plast Surg.. 1996;  49 220-2
    CrossrefPubMedGoogle Scholar
  • 35 Robicsek F, Hamilton D A. Presternal muscle padding following midline sternotomy.  J Card Surg.. 1989;  4 299-301
    PubMedGoogle Scholar
  • 36 Sanger P W, Robicsek F, Daugherty H K. The repair of recurrent pectus excavatum.  J Thorac Cardiovasc Surg.. 1968;  56 141-3
    PubMedGoogle Scholar
  • 37 Robicsek F, Cook J W, Rizzoni W. Sternoplasty for incomplete sternum separation.  J Thorac Cardiovasc Surg.. 1998;  116 361-2
    PubMedGoogle Scholar
  • 38 Chlosta W F, Elefteriades J A. Simplified method of reinforced sternal closure.  Ann Thorac Surg.. 1995;  60 1428-9
    CrossrefPubMedGoogle Scholar
  • 39 Liu H P, Chang C H, Lin P J, Chu J J, Hsieh H C, Chang J P, Hsieh M J. Migration of Kirschner wire from the right sternoclavicular joint into the main pulmonary artery. A case report.  Chang Keng I Hsueh.. 1992;  15 49-53
    PubMedGoogle Scholar
  • 40 Geiger J P, Tabak C A, Aronstam E M. Primary sternal closure and mediastinal decompression by inlay autologous rib grafts.  Ann Thorac Surg.. 1996;  61 215-6
    CrossrefPubMedGoogle Scholar
  • 41 Chiu W C, D'Amelio L F, Hammond J S. Sternal fractures in blunt chest trauma: a practical algorithm for management.  Am J Emerg Med.. 1997;  15 252-5
    CrossrefPubMedGoogle Scholar

MD Phd Francis Robicsek

Department of Cardiovascular and Thoracic Surgery and Heineman Medical Research Laboratory Carolinas Medical Center

1001 Blythe Boulevard Suite 300 Charlotte, North Carolina 28203 USA

Phone: Tel. +001-704-373-0212

Fax: Fax +001-704-373-1249

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