ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Thermoreactive nitinol clips for re-sternotomy in cases of sternal dehiscence
Sabit Sarıkaya, Fuat Büyükbayrak, Özge Altaş, Onur Yerlikhan, Ali Fedakar, Murat Rabuş, Kaan Kırali
Department of Cardiovascular Surgery, Kartal Koşuyolu Heart Education and Research Hospital, İstanbul, Turkey
DOI : 10.5606/tgkdc.dergisi.2013.7603
Background: This study aims to evaluate the effectiveness, reliability, advantages, disadvantages and the application technique of the thermoreactive nitinol clips (TRNC) used for sternal closure in patients with sternal dehiscence.

Methods: Between January 2010 and March 2012, we used TRNCs for sternal closure in 24 patients (13 males, 11 females; mean age 67±4 years; range, 53 to 79 years) with sternal dehiscence in Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, Cardiovascular Outpatient Clinic. All patients with sternal dehiscence after primary cardiac surgery were identified before the hospital discharge. They underwent sternal revision on postoperative 12±3 days (range, 6 to 18 days). Substernal tissues were not dissected in 19 patients whose sternums had been closed with TRNC, while the rest of the patients underwent substernal tissue dissection due to the risk for deep sternal wound infection. Subsequently, high risk tissues with suspected infection were debrided and curated.

Results: A total of 33.3% (n=8) had superficial sternal wound infection, while 4.1% (n=1) had deep sternal wound infection. One patient who underwent substernal dissection during revision surgery developed right atrial injury due to adhesion of giant atrium to the sternum. No in-hospital mortality was observed. No complications of sternotomy including recurrent sternal dehiscence, sternal abscess, mediastinitis or secondary osteomyelitis were reported during the six-month follow-up period.

Conclusion: Early surgical intervention should be considered in patients with sternal dehiscence to break the vicious circle of infection-mechanical disorder-dehiscence and to minimize the risk for mediastinitis. We recommend using TRNCs as the first treatment of choice for sternal closure in patients with sternal dehiscence thanks to its easy and safe utilization during surgery, shorter length of hospital stay, relatively lower cost and patient comfort.

Keywords : Deep sternal infection; sternal closure; sternal dehiscence; thermoreactive nitinol clip
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