ABSTRACT
BACKGROUND: Sternal dehiscence after full median sternotomy may result in wound-healing disorders, including osteomyelitis. The consequences are extended hospitalization, plastic surgery, stress for the patient, and increased costs. Stable closure of the median sternotomy plays a crucial role in the avoidance of sternal dehiscence and osteomyelitis. METHODS: All patients who underwent full sternotomy from January 1999 until December 2001 were investigated with respect to the incidence of sternal dehiscence. Since January 2000, patients supposed to be at risk for sternum dehiscence were more frequently treated with an Ethicon steel band at the third intercostal space in addition to standard osteosynthesis with 8 wire cerclages. RESULTS: Since the introduction of this method, the incidences of sternal dehiscence and sternal wound infections decreased from 2.9% and 0.9 %, respectively, in 1999 to 0.3% and 0.2%, respectively, in 2001. This decline resulted in shorter postoperative hospital stays, less stress for the patients, and substantial reductions in postsurgical costs. CONCLUSIONS: A steel band used in addition to standard osteosynthesis with 8 wire cerclages is a safe and effective procedure resulting in a statistically significant decrease in the frequency of sternal dehiscence.
Subject(s)
Bone Wires , Risk Assessment/methods , Sternum/surgery , Surgical Wound Dehiscence/epidemiology , Thoracic Surgical Procedures/instrumentation , Thoracic Surgical Procedures/statistics & numerical data , Aged , Female , Germany/epidemiology , Humans , Incidence , Male , Middle Aged , Risk FactorsABSTRACT
BACKGROUND: Avoiding tangential clamping of the ascending aorta during coronary bypass operations reduces the trauma to the aorta and may avoid local particulate embolization. METHODS: From December 2000 to May 2001, 21 male patients, mean age 64.1 +/- 7.2 years (range, 46-76 years), with coronary artery 2-vessel (n = 3) and 3-vessel (n = 18) disease were divided randomly into 2 groups and underwent myocardial revascularization. In 11 patients an aorta-saphenous vein graft anastomosis was performed with the CorLink device for anastomosis between the saphenous vein and the ascending aorta. Ten patients served as control subjects. In these patients the central bypass anastomosis was performed with a 6-0 running suture. Clinical follow-up was performed 1 month and 3 months postoperatively. Six months after surgery, multislice computed tomography was performed to evaluate bypass patency for all patients. RESULTS: Mean number of study vessels was 1.2 +/- 0.4 in the CorLink group and 1.5 +/- 0.5 in the control group. In the CorLink group, 13 additional arterial and vein grafts were performed, and in the suture control group 15 additional mammary artery grafts were carried out. No intraoperative complications occurred. In 2 CorLink anastomoses an additional stitch was necessary because of minor bleeding. Follow-up was carried out at 6 months with multislice computed tomography for all patients and showed only 1 study vessel occlusion in the CorLink group. All 62 other bypass grafts were revealed to be patent and had anastomoses of good quality. CONCLUSION: Our experience suggests that the CorLink device is a safe and effective technique for anastomosis between saphenous vein grafts and the ascending aorta. The CorLink device could be used for totally endoscopic coronary bypass operations. Further randomized studies enrolling a larger number of patients are necessary to determine which patients may benefit the most from this procedure.
