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Cable Sternal Closure: A Word of Caution Louis Samuels, MD Professor of Surgery– Thomas Jefferson University School of Medicine, Philadelphia, PA Surgical.

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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:

1 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

2 YearCasesSternal ComplicationsPercentage < 1% sternal wound complication rate prior to and after study dates when Sternal Wires were used exclusively

3 Sternal Cable Complication Cases 15 Cases 9 Male, 6 Female Age: 40 – 81 yrs (mean: 65.5 yrs) 11 CABG 01 AVR 01 MVR 01 AVR/CABG 01/AVR/MVR/CABG No identifiable patient factor, case type, closure technique, or any other demographic pattern associated with sternal complication. Age Sex Original ProcedureSign PMH BMI Sternal Closure*Interval** IndicationTreatment 73F CABGDM-II, XRT (Breast CA) 25 3 FO81105 PainRemoval Lower Cable 67M AVR/CABGN/A 22 3 FO8451 PainRemoval Upper Cable 68F MVRN/A 21 2 FO8738 Pre-PenetrationTotal Cable Removal 81M CABGObesity, DM-II 30 2 Single, 2 FO8726 PainTotal Cable Removal 87F CABGOsteoporosis 24 4 FO8604 PainTotal Cable Removal 66M CABGN/A 23 3 FO8508 PainTotal Cable Removal 48M CABGN/A 26 5 FO8238 Pre-PenetrationTotal Cable Removal 76M AVR/MVR/CABGObesity 33 4 FO8131 Pre-PenetrationRemoval Lower Cable 59M CABGN/A 26 5 FO8 53 Pain/BlisteringTotal Cable Removal 40M CABGIDDM 23 5 FO8 68 Infection (S. aureus)Total Cable Removal 59M CABGN/A 26 5 FO8368 PainTotal Cable Removal 68M CABGN/A 25 5 FO8 69 Pain/DiscolorationTotal Cable Removal 69F AVRN/A 28 3 FO8 15 Infection (K. pneum)Removal Upper Cable 65F CABGDM-II 28 2 Single, 3 FO8 190 PainRemoval Lower Cable 56F CABGXRT (Lymphoma) 26 2 Single, 4 FO8 177 PainTotal Cable Removal *FO8= Figure of 8 **Interval (days) between Original Procedure and Sternal Cable Removal

4 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

5 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)

6 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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