Akademik Veri Yönetim Sistemi
Turkiye Klinikleri Journal of Medical Sciences, cilt.26, sa.1, ss.51-55, 2006 (SCI-Expanded)
Objective: Median sternotomy is still the most popular method in cardiac surgery. Although it is uncommon, postoperative complications of the sternotomy incision, additively increases morbidity and mortality. To avoid postoperative complications, optimal sternal fixation is necessary. For this reason, we primarily combined the figure of eight and the Robicsek method in patients with risk factors. Material and Methods: This study includes patients who had undergone cardiac surgery between January 2000 and January 2002 in Ankara University Faculty of Medicine, Department of Cardiovascular Surgery. The risk factors in the study group comprising 30 patients were as follows: Obesity, low cardiac output syndrome, diabetes mellilus, chronic obstructive pulmonary disease, old age, resternotomy, malnutrition, osteoporosis, previous radiotherapy to chest region, immunodeficiency, sternal trauma. Similar risk factors were present in the control group consisting of 30 patients. Demographic distribution of the control group was 8 (26.6%) male and 22 (73.3%) female patients with a mean age of 65.4 ± 6.4 (51-78) Technically, we combined the Robicsek method and the figure of eight. First, we stabilized costochondral junctions with stainless steel wire starting from the manubrium extending to the xyphoid process. This was achieved by passing the wire through the intercostal spaces anteriorly and posteriorly in an alternating sequence up to the xyphoid process. The same wire was reversed to pass through the intercostal spaces in the reverse direction from the xyphoid process up to the manubrium. Free ends of the wire on the anterior plane of the manubrium were twisted. The same fixation process was performed at the other edge of the sternum. Figure of eight was used to close the sternotomy incision but wires were passed lateral to the fixating wires of Robicsek. Patients closed with our technique were followed-up for complications such as infection, separation and mediastinitis. Besides, the effect of this technique on the operation time and bleeding were investigated. Results: We did not encounter any sternal complication in the study group except for one patient. There was no significant difference with regard to postoperative bleeding and operation time between the study group and the control group. Conclusion: We suggest that this technique reduces stress on the sternum, optimizes sternal fixation and reduces morbidity and mortality in patients with risk factors. Copyright © 2006 by Türkiye Klinikleri.