Management
Bhagwat et al. ([PMID:26536080]) describe a method that tightens all four wires equally, offering higher strength and rigidity compared to conventional techniques, ensuring a more secure sternal fixation post-dislocation repair.
According to Bhagwat et al. ([PMID:26536080]), the modified tightening approach for figure-of-eight wiring not only enhances stability but also streamlines the closure process, making it more efficient in clinical settings.
This novel technique facilitates stable bone healing and allows for conventional wiring by providing landing zones on either side of the sternum [PMID:25087833].
The authors propose that their fibula allograft sandwich technique represents an advancement over traditional synthetic materials by potentially improving healing outcomes [PMID:25087833].
In vitro studies [PMID:17377844] demonstrate that specific plate configurations, particularly three x-shaped plates or a single box-shaped plate, provide the most stable closure by minimizing sternal separation, which is crucial for reducing post-operative healing complications.
Complications
Bhagwat et al. ([PMID:26536080]) suggest that by avoiding loose loops through their tightening technique, the incidence of complications such as non-union or hardware-related issues might be minimized in patients undergoing sternal closure.
The paper highlights that sternal dehiscence is a serious complication contributing to prolonged hospital stays and higher costs, underscoring the need for effective reconstruction methods [PMID:25087833].
The study [PMID:17377844] highlights that variations in plate type, location, and number can result in substantial sternal separation, with measurements ranging from minimal (0.03 +/- 0.53 mm) to considerable (4.24 +/- 1.26 mm) at critical areas like the xiphoid, indicating potential complications if optimal configurations are not used.
Key Recommendations
While current in vitro research [PMID:17377844] identifies effective plate configurations, it underscores the need for more accurate in vivo loading data to enhance the predictive value of laboratory testing methods for clinical practice. (Evidence: Expert opinion)
References
1 Bhagwat KA, Stephens GC, Chakaramakkill MJ, Ratinam R. Modified Tightening for Figure-of-Eight Sternal Wiring Closure. Innovations (Philadelphia, Pa.) 2015. link 2 Ersoy C, Özyüksel A, Malkoç M, Kayhan B, Kayan E, Akçevin A et al.. Fibula allograft sandwich technique for the reconstruction of sternal nonunion after cardiac surgery. The Annals of thoracic surgery 2014. link 3 Pai S, Gunja NJ, Dupak EL, McMahon NL, Coburn JC, Lalikos JF et al.. A mechanical study of rigid plate configurations for sternal fixation. Annals of biomedical engineering 2007. link