Volume 1, Issue 3, September 2015, Page: 38-41
Figure-of-Eight Wire Sternal Closure Technique Can Reduce Post-Open Cardiovascular Surgery Chest Re-Exploration and Pain Scores in Diabetic Patients with Severe Obesity (Body Mass Index: 35-40)
Seyed Jalil Mirhosseini, Department of Cardiac Surgery, Afshar Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
Sadegh Ali-Hassan-Sayegh, Yazd Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
Seyed Mohammad Yousof Mostafavi-Pour-Manshadi, Yazd Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran; Department of Medicine, Ali ben Abitalib Medical College, Islamic Azad University, Yazd, Iran
Nafiseh Naderi, Yazd Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran; Department of Medicine, Ali ben Abitalib Medical College, Islamic Azad University, Yazd, Iran
Maryam Hadibarhaghtalab, Non-Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
Mohammad Reza Lotfaliani, Yazd Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
Received: Jun. 8, 2015;       Accepted: Aug. 10, 2015;       Published: Aug. 11, 2015
DOI: 10.11648/j.ijcems.20150103.12      View  3764      Downloads  71
Abstract
Background. Postoperative sternal instability can be associated with the density of bone and type of wire closure. Sternal instability is a serious complication, especially in diabetic obese patients. This category of patients is susceptible to activation of inflammation and inflammatory and/or infective involvement of the sternum after sternotomy. This study was designed to evaluate the comparison of safety and efficacy of figure-of-eight with simple wire sternal closure technique in high-risk diabetic severe obese patients [Body mass index (BMI): 35-40]. Methods and materials. This study, conducted on 80 diabetic patients with severe obesity (BMI: 35-40) undergoing elective off-pump coronary artery bypass graft (CABG) surgery in duration from the first day to two weeks after surgery. Sternal wire closure techniques are divided into two groups, group A (n=40), patients undergoing simple wire closure and group B (n=40), patients undergoing figure-of-eight wire closure. Results. The average age of patients was 64.7±13.2 years. According to the patient self-rated numeric pain intensity scale, the pain of sternum related to existing of wire closure was classified to mild [(group A: n=14), (group B: n=17)], moderate [(group A: n=14), (group B: 19)], and severe [(group A: n=12), (group B: 4)]. Postoperative pain scores had significant higher difference in simple closure than figure-of-eight technique. From all patients, three cases with figure-of-eight and seven cases with simple wire closure had chest re-exploration after surgery. Chest re-exploration in group of figure-of-eight was lower than group of simple closure significantly (p=0.03). Postoperative utilization of inotropic agents, mediastinitis, cerebrovascular accident (CVA) and atrial fibrillation (AF) had not significant differences between both techniques. Conclusion. These findings show that figure-of-eight sternal wire closure technique can reduce postoperative pain scores and chest re-exploration significantly in diabetic patients with severe obesity.
Keywords
Figure-of-Eight Wire Sternal Closure, Obesity, Diabetic Patients, Off Pump CABG
To cite this article
Seyed Jalil Mirhosseini, Sadegh Ali-Hassan-Sayegh, Seyed Mohammad Yousof Mostafavi-Pour-Manshadi, Nafiseh Naderi, Maryam Hadibarhaghtalab, Mohammad Reza Lotfaliani, Figure-of-Eight Wire Sternal Closure Technique Can Reduce Post-Open Cardiovascular Surgery Chest Re-Exploration and Pain Scores in Diabetic Patients with Severe Obesity (Body Mass Index: 35-40), International Journal of Clinical and Experimental Medical Sciences. Vol. 1, No. 3, 2015, pp. 38-41. doi: 10.11648/j.ijcems.20150103.12
Reference
[1]
Sá MP, Ferraz PE, Escobar RR, et al. Off-pump versus on-pump coronary artery bypass surgery: meta-analysis and meta-regression of 13,524 patients from randomized trials. Rev Bras Cir Cardiovasc. 2012; 27:631-641.
[2]
Tekümit H, Cenal AR, Tataroğlu C, Uzun K, Akinci E. Comparison of figure-of-eight and simple wire sternal closure techniques in patients with non-microbial sternal dehiscence. Anadolu Kardiyol Derg. 2009;9:411-416.
[3]
Molina JE, Lew RS, Hyland KJ. Postoperative sternal dehiscence in obese patients: incidence and prevention. Ann Thorac Surg. 2004;78:912-917.
[4]
Kamiya H, Al-maisary SS, Akhyari P, et al. The number of wires for sternal closure has a significant influence on sternal complications in high-risk patients. Interact Cardiovasc Thorac Surg. 2012;15:665-670.
[5]
Cullen A, Ferguson A. Perioperative management of the severely obese patient: a selective pathophysiological review. Can J Anaesth. 2012;59:974-996.
[6]
Shaikhrezai K, Robertson FL, Anderson SE, Slight RD, Brackenbury ET. Does the number of wires used to close a sternotomy have an impact on deep sternal wound infection? Interact Cardiovasc Thorac Surg. 2012;15:219-222.
[7]
Olbrecht VA, Barreiro CJ, Bonde PN, et al. Clinical outcomes of noninfectious sternal dehiscence after median sternotomy. Ann Thorac Surg. 2006;82:902-907.
[8]
Raman J, Lehmann S, Zehr K, et al. Sternal closure with rigid plate fixation versus wire closure: a randomized controlled multicenter trial. Ann Thorac Surg. 2012;94:1854-1861.
[9]
Aykut K, Celik B, Acıkel U. Figure-of-eight versus prophylactic sternal weave closure of median sternotomy in diabetic obese patients undergoing coronary artery bypass grafting. Ann Thorac Surg. 2011;92:638-641.
[10]
Ramzisham AR, Raflis AR, Khairulasri MG, Ooi Su Min J, Fikri AM, Zamrin MD. Figure-of-eight vs. interrupted sternal wire closure of median sternotomy. Asian Cardiovasc Thorac Ann. 2009;17:587-591.
[11]
Vural AH, Yalçinkaya S, Türk T, et al. Sternal closure reinforced with rib heads: a novel technique for prevention and treatment of sternal dehiscence. Heart Surg Forum. 2007;10:E397-400.
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