Sternal wound dehiscence after median sternotomy: An alternative closure technique

2021 ◽  
Author(s):  
Filippo Tommaso Gallina ◽  
Enrico Melis ◽  
Daniele Forcella ◽  
Francesco Facciolo
Keyword(s):  
Median Sternotomy ◽  
Wound Dehiscence ◽  
Closure Technique ◽  
Sternal Wound Dehiscence

scholarly journals OV09 ROBOTIC REPAIR OF SUBXIPHOID INCISIONAL HERNIA POST CABG

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Moamena El-Matbouly ◽  
Yaser Janahi ◽  
Ahmed Suliman ◽  
Hany Atalah ◽  
Ahmed Albahrani
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
Complex Structure ◽  
Median Sternotomy ◽  
Wound Dehiscence ◽  
High Recurrence Rate ◽  
Linea Alba ◽  
Prolonged Intubation ◽  
Sternal Wound Dehiscence ◽  
Upper Abdominal

Abstract Aim A median sternotomy that extends toward the epigastric area can weaken the upper abdominal wall and result in the development of subxiphoid incisional hernia. We aim to assess the efficacy and the feasibility of repair of subxiphoid incisional hernia post CABG robotically. In this video; we will also review the surgical technique and the steps for robotic repair of subxiphoid incisional hernia Material and Methods 57-year-old female presented with subxiphoid swelling post CABG in 2019. Her surgery was complicated with sternotomy wound infection with VAC dressing application and ARDS with prolonged intubation. She had 5x7 cm hernia defect that showed on the CT thorax along with sternal wound dehiscence. She underwent robotic repair of her hernia with phasix mesh and recovered well after surgery. Results The subxiphoid hernia is known for its repair complexities and high recurrence rate because the subxiphoid area is a complex structure consisting of boney structures, the rectus abdominis muscles, linea alba, and the diaphragm. The Da Vinci platform allows for accessing hard-to reach area with enhanced precision in dissection and superior dexterity compared to laparoscopy. The Robotic platform allows for manipulation of the camera to assess and operate on the abdominal wall with ease as compared to laparoscopy. Conclusions robotic repair of subxiphoid incisional hernia with mesh is safe and effective method of repair. There are no short-term or long- term side effects of the procedure with no recurrence at 6 months follow up.

scholarly journals COMPARISON OF INCIDENCE OF STERNAL WOUND DEHISCENCE AFTER SIMPLE INTERRUPTED STERNAL CLOSURE VS FIGURE-OF-EIGHT STERNAL CLOSURE IN PATIENTS OF CORONARY ARTERY BYPASS GRAFT SURGERY

2021 ◽  
Vol 70 (Suppl-4) ◽  
pp. S726-30
Author(s):  
Muhammad Ashfaq ◽  
Nasir Ali ◽  
Asif Mahmood Janjua ◽  
Naser Ali Khan ◽  
Ali Gohar Zamir ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Wound Dehiscence ◽  
Artery Bypass Graft ◽  
Closure Technique ◽  
Sternal Closure ◽  
Sternal Wound Dehiscence

Objective: To compare the incidence of sternal wound dehiscence between simple interrupted vs. figure-of-eight sternal closure techniques for median sternotomy in patients undergoing coronary artery bypass graft surgery. Study Design: Comparative prospective, randomized control trial. Place and Duration of Study: Study conducted at Department of Cardiac Surgery, Armed Forces Institute of Cardiology Rawalpindi, from Apr to Dec 2019. Methodology: A total of 206 patients were included in study. These patients were divided into two groups; group “A”: cases which will undergo simple interrupted sternal wire closure technique (n1=103). Group “B”: cases which will undergo figure-of-eight sternal wire closure technique (n2 = 103). Results: There were no statistical difference in the pre-operative data of the patients. The incidence of sternal wound dehiscence in simple interrupted closure was 6.79% while in figure of eight closure technique it was noted to be 1.94%. A statistically significant difference was noted in both the closure technique (p<0.05). Conclusions: Figure-of-eight sternal wire closure technique provides better strength and stability to sternum along with reduced incidence of sternal wound dehiscence as compare to simple interrupted wire closure.

scholarly journals Impact of vacuum-assisted closure therapy on outcomes of sternal wound dehiscence

2014 ◽  
Vol 19 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Vincenzo Tarzia ◽  
Massimiliano Carrozzini ◽  
Giacomo Bortolussi ◽  
Edward Buratto ◽  
Jonida Bejko ◽  
...  
Keyword(s):  
Wound Dehiscence ◽  
Vacuum Assisted Closure ◽  
Sternal Wound Dehiscence ◽  
Vacuum Assisted Closure Therapy

Unilateral Pedicled Pectoralis Major Harvested by Endoscopic-Assisted Method Achieves Adequate Management of Sternal Infection and Mediastinitis

2019 ◽  
Vol 35 (09) ◽  
pp. 705-712
Author(s):  
Chih-Hung Lin ◽  
Cheng-Hung Lin ◽  
Feng-Chun Tsai ◽  
Pyng-Jing Lin
Keyword(s):  
Donor Site ◽  
Median Sternotomy ◽  
Recurrent Infection ◽  
Wound Dehiscence ◽  
The Other ◽  
Sternal Infection ◽  
Multiple Organs ◽  
Postoperative Hematoma ◽  
Sternal Wound Infections ◽  
Adequate Management

Background Bilateral PM muscles or combination with rectus abdominis or omentum are commonly used for upper and lower sternal wound infections. Unilateral PM harvesting using endoscopic-assisted method may have a simple, safe, and reliable entire muscle harvesting with comparable result of less donor-site violation. Methods A retrospective review was performed from 2003 till 2015 on 38 patients referred to a single plastic surgeon for treatment of sternal wound infection following median sternotomy for cardiovascular surgery. After the humerus insertion of PM was cut with the assistance of endoscope visualization, all the other PM insertions on the sternum, rib, and clavicle were divided, the unilateral pedicled PM can be advanced approximately 10 cm to cover the cephalad and caudal sternum, and fill the retrosternal mediastinum. Results Four re-explorations in three patients for postoperative hematoma occurred. No early recurrent infection for wound dehiscence experienced. Three patients died of multiple organs failures as 30-day mortality. Two patients underwent late recurrent infections; one patient had twice wire infection removals at 4 and 6 months after transfer, and the other had another PM for rib osteomyelitis in 3 years. Conclusion Unilateral PM transfer is justified to provide a simple, reliable, straightforward procedure for sternal infection management and mediastinal obliteration without violation of second flap in compromised patients.

scholarly journals Topical negative pressure for the treatment of neonatal post-sternotomy wound dehiscence

2012 ◽  
Vol 94 (1) ◽  
pp. e33-e35 ◽  
Author(s):  
J Hardwicke ◽  
H Richards ◽  
J Jagadeesan ◽  
T Jones ◽  
R Lester
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Wound Dehiscence ◽  
Ion Concentration ◽  
Local Effects ◽  
Hydrogen Ion Concentration ◽  
Early Management ◽  
Topical Negative Pressure ◽  
Arterial Blood ◽  
Sternal Wound Dehiscence

The use of topical negative pressure (TNP) dressings for sternal wound dehiscence or mediastinitis in the neonatal population is rare. The majority of case reports have focused on wound healing as an endpoint and have not discussed the physiological advantage that TNP dressings may impart with regard to sternal stabilisation, improved respiratory function and early weaning from mechanical ventilation. We present a case of the use of TNP in neonatal post-sternotomy wound dehiscence and mediastinitis, from a UK perspective, with an emphasis on wound healing and physiological optimisation. As well as an improvement in sternal wound healing due to the local effects of the TNP system, serial arterial blood gas analysis revealed a significant improvement in systemic physiological parameters, including a reduction in pCO2 in the period (days 20–31) after application of TNP (p<0.0001) compared to the period before where simple occlusive dressings were applied. Hydrogen ion concentration also significantly reduced in this period (p=0.0058). The use of the TNP system in association with systemic antibiotics successfully treated the mediastinitis. A sealed, controlled wound environment also allowed ease of nursing and an expedited return to care by the parents. We would recommend the consideration of TNP dressings in similar cases of neonatal and paediatric sternal wound dehiscence. Not only do we observe the local effects of improved wound healing, the systemic effects of improved lung function are also valuable in the early management of such complex cases.

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