Presentation on theme: "Cable Sternal Closure: A Word of Caution Louis Samuels, MD Professor of Surgery– Thomas Jefferson University School of Medicine, Philadelphia, PA Surgical."— Presentation transcript:
Cable Sternal Closure: A Word of Caution Louis Samuels, MD Professor of Surgery– Thomas Jefferson University School of Medicine, Philadelphia, PA Surgical Director HF & LVAD ProgramLankenau Medical Center, Wynnewood, PA Chief CardioThoracic Surgery– Bryn Mawr Hospital, Bryn Mawr, PA
2008 - 2012 YearCasesSternal ComplicationsPercentage 200810643.8 20099844.1 201010854.6 20118411.2 20128711.1 < 1% sternal wound complication rate prior to and after study dates when Sternal Wires were used exclusively
Closure Techniques 15 Cases (5)- 5 Cables, All Figure of 8 (2)- 4 Cables, All Figure of 8 (4)- 3 Cables, All Figure of 8 (1)- 2 Cables, All Figure of 8 (1)- 4 Cables Figure of 8, 2 Cables Single (1)- 3 Cables Figure of 8, 2 Cables Single (1)- 2 Cables Figure of 8, 2 Cables Single 3 Fig of 8 4 Fig of 8 4 Fig of 8, 2 Single 2 Fig of 8, 2 Single
Results Indications for Cable Removal 10– Pain 03– Impending Skin Penetration 02– Infection (1- Klebsiella, 1- S. aureus) Treatments 10– Removal of All Cables 05– Removal of 1 Cable Outcomes No Subsequent Sternal Issues Pain Gone, Infection Cleared, No Dehiscence Interval: Original Surgery to Cable Removal Mean: 363 days (range: 15 – 1105 days)
Conclusions The use of sternal cables for sternal closure during cardiac surgery was associated with a significant incidence of sternal wound complications requiring removal. The majority of the complications were related to persistent pain. Although bone integrity was intact (except for one case) at the time of removal, the use of sternal cables should be considered with caution. There may be something inherent in the cable that elicits an inflammatory reaction to the soft tissue.
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