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What is a Sternotomy?
The midline sternotomy is created with a bone saw and used to access the mediastinum. The sternotomy is utilized more that 400,000 times a year in the United States. A simple 316L Stainless Steel wire circlage is the most commonly used closure method. This method has a number of technological and structural weaknesses.
Traditional Steel Wire Circlage Closure of the Sternum
This video demonstrates a traditional wire cerclage of the sternum. As you can see in the video, the security of the wires is created simply by twisting the wires together to near their failure point.
When Standard Steel Wires for Sternotomy Fail: Dehiscence
Example which demonstrates what can happen if the standard steel wire cerclage snaps or cuts-through the sternal halves and the sternum opens. Substrata of patients with increased risk tend to be elderly, obese, osteoporotic, diabetic, or have long pump runs. However many patients may simply experience postoperative bone pain from loose sternal halves. Unfortunately the surgeon never knows who might have problems after surgery. That is why having a strong and secure primary closure device is critical to outcomes.
This is an excellent example of a Vertical Rectus Abdominis Flap repair of large sternal dehiscence after open heart surgery. Traditional simple steel wire was used. Patient required 56 days in the hospital, 38 days in the ICU, 6 operations, tracheostomy, gastrostomy tube with tube feeds, and 4 weeks rehab. Preventing these type traditional sternal wire complications is the driving force behind the Figure 8 Sternal closure device.
This is an example of a pectoralis major rotational flap for coverage of sternal non union following open heart surgery. This is a workhorse of sternal closure following dehiscence. It has a reliable blood supply and arc of rotation.