The Use of Suture Anchors for Sternal Nonunion as a New Technical Approach (Demircin-Dogan Technique)

Authors

  • Omer Faruk Dogan
  • Metin Demircin
  • Umit Duman
  • Fatma Ozsoy
  • Emre Acaroglu

DOI:

https://doi.org/10.1532/HSF98.20051024

Abstract

Objectives: Various comparative studies and techniques have been described for median sternotomy closure in the literature, previously. However, some patients are still under risk of sternal dehiscence, malunion or nonunion due to intrinsic or extrinsic factors after median sternotomy closure. Sternal nonunion described as sternal pain, with clicking, instability, or both for more than 3 months in the absence of infection, is an uncommon complication of midline sternotomy incision. To date, only a few studies have addressed the entity of sternal nonunion and its treatment.

Material and Method: The suture anchor system has been described for the fixation of tendons or ligaments to the bone in the orthopedic, and then in cardiac surgery for closure of sternum. In the present study, we used different methods for correction and reduction of sternal nonunion with the use of suture anchors and it accompanied steel wires as an alternative technique in a male patient after coronary artery bypass grafting.

Results: There was no complication due to suture anchors. Sternal stability, reduction, and fixation were achieved successfully.

Conclusion: Sternal nonunion and dehiscence may be the cause of prolonged hospitalization and increased mortality and morbidity if the patient is not treated surgically. This device may protect the wire from cutting into the sternal bone because the thoracal lateral enforcement may be decreased by the devices when the patient is breathing, and with upper extremity movement. This technique can be used easily, safely, and effectively in the repair of sternal nonunion.

References

Goldman G, Nostel R, Spir E, Vidne B. 1998. Effective technique of sternum closure in high risk patients. Arch Surg 123:386-7.nHendrickson SC, Koger KE, Morea CJ, Aponte RL, Smith PK, Levin LS. 1996. Sternal plating for the treatment of sternal nonunion. Ann Thorac Surg 62:512-8.nMayba II. 1985. Non-union of fractures of sternum. J Bone Joint Surg Am 67:1091-3.nMcGregor NE, Trumble DR, Magovern JA. 1999. Mechanical analyses of midline sternotomy wound closure. J Thorac Cardiovasc Surg 117:1144-50.nBarber FA, Herbert MA, Click JN. 1995. The ultimate strength of suture anchors. Arthroscopy 11:21-8.nBertin KC, Rice RS, Doty DB, Jones KW. 2002. Repair of transverse sternal nonunions using metal plates and autogenous bone graft. Ann Thorac Surg 73:1661-2.nCoons DA, Pitcher JD, Braxton M, Bickley BT. 2002. Sternal nonunion. Orthopedics 25:89-91.nDogan OF, Oznur A, Demircin M. 2004. A new technical approach for sternal closure with suture anchors (Dogan Technique). Heart Surg Forum 7:328-32.nEich BS, Heinz TR. 2000. Treatment of sternal nonunion with Dall Miles cable system. Plast Reconstr Surg 106:1075-8.nEl Oakley RM, Wright JE. 1996. Postoperative mediastinitis: classification and management. Ann Thorac Surg 61:1030-6.nOznur A. 2002. A new technique for fixation of distal chevron osteotomy. Foot & Ankle Int 23(10):949-51.nSatta J, Lahtinen J, Raisanen L, Salmela E, Juvonen T. 1998. Options for the management of poststernotomy mediastinitis. Scan Cardiovasc J 32:29.nTavilla G, van son JAM, Verhagen AF, Lacquet LK. 1991. Modified Robiscek technique for complicated sternal closure. Ann Thorac Surg 52:1179-80.nWu LC, Renucci J, Song DH. 2004. Rigid-plate fixation for the treatment of sternal nonunion. J Thorac Cardiovasc Surg 128:623-4.nOzaki W, Buchmann SR, Lannettoni MD, Frankenburg EP. 1998. Biomechanical study of sternal closure using rigid fixation techniques in human cadavers. Ann Thorac Surg 65:1660-5.nSirivelle S, Zikria EA, Ford WB, Samadeni SR, Miller WH, Sullivan ME. 1987. Improved technique for sternal closure of median sternotomy incision: mersilene tapes versus standard wire closure. J Thorac Cardiovasc Surg 94:591-5.nStahle E, Tammalin A, Bergstroom R, Hambreus A, Nystrom SO, Hanssen HE. 1997. Sternal wound complications-incidence, microbiology and risk factors. Eur J Cardiovasc Surg 11:1146-53.n

Published

2005-08-29

How to Cite

Dogan, O. F., Demircin, M., Duman, U., Ozsoy, F., & Acaroglu, E. (2005). The Use of Suture Anchors for Sternal Nonunion as a New Technical Approach (Demircin-Dogan Technique). The Heart Surgery Forum, 8(5), E364-E369. https://doi.org/10.1532/HSF98.20051024

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