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Grant AA, Moore C, Smith RN, Sciarretta JD, Sola R, Udobi K, Williams KN, Busby S, Butler C, Keeling B, Ghodsizad A, Nguyen J. Rigid Plate Fixation for Closure of Emergent Sternotomies for Trauma. Am Surg 2024; 90:648-654. [PMID: 37842929 DOI: 10.1177/00031348231206577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND No studies to date have evaluated the use of rigid plate fixation for emergent sternotomy in trauma patients. We evaluated our use of rigid plate fixation vs wire cerclage in patients requiring emergent sternotomy. We hypothesized there would be no difference in complications related to sternal closure between the two groups. METHODS We performed a retrospective cohort study to include all patients who underwent emergent sternotomy from 1/1/2018 to 1/31/2021 and survived to have their sternum closed. Outcomes in patients closed with wire cerclage group (WC) were compared to patients who underwent rigid plate fixation (RPF). RESULTS Twenty-two patients underwent emergent sternotomy. There were 11 patients in each group. There was no significant difference in admission demographics, ISS, or admission characteristics between the two groups. Complication rates related to closure (wound infection and hardware removal) were not significantly different (WC 27% vs RPF 9%, P = .58). Neither hospital length of stay (WC: 29 days vs RPF: 13 days, P = .13), ICU length of stay (WC: 6 days vs RPF: 7 days, P = .62), nor the number of ventilator days (WC: 3 days vs RPF: 1 day, P .11) were statistically different. All patients survived to discharge. DISCUSSION This is the first study comparing RPF and WC for sternotomy closure in the setting of trauma. We found no difference in the rate of wound related complications. This study demonstrates the feasibility of rigid plate fixation for trauma sternotomy closure and lays the foundation for future prospective studies.
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Affiliation(s)
- April A Grant
- Department of Surgery, Saint Alphonsus Regional Medical Center, Boise, ID, USA
| | - Cameron Moore
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Randi N Smith
- Department of Surgery at Grady, Emory University, Atlanta, GA, USA
| | | | - Richard Sola
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
- Department of Surgery, Wellstar Health System, Marietta, GA
| | - Khadi Udobi
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Keneeshia N Williams
- Department of Surgery, Grady Memorial Hospital, Atlanta, GA, USA
- Department of Surgery, Wellstar Health System, Marietta, GA
| | | | - Caroline Butler
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Brent Keeling
- Emory University School of Medicine, Atlanta, GA, USA
| | - Ali Ghodsizad
- University of Miami School of Medicine, Miami, FL, USA
| | - Jonathan Nguyen
- Department of Surgery, Grady Memorial Hospital, Atlanta, GA, USA
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Harder Y, Krapf J, Rieck B, Schaefer DJ, Djedovic G, Kutschka I, Graf K, Kneser U, Horch RE, Lehnhardt M, Pierer G. [Deep sternal wound infection after sternotomy - Report of the consensus workshop of the German-Speaking Society for Microsurgery of Peripheral Nerves and Vessels (DAM)]. HANDCHIR MIKROCHIR P 2021; 53:519-525. [PMID: 33951736 DOI: 10.1055/a-1425-5987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Deep sternal wound infection (TSWI) is a potentially life-threatening complication that may occur after median sternotomy, contributing to prolonged hospital stay and increased health care costs. Bacterial infection is often characterized by biofilm formation on implant material and/or dead bone. Diagnosis is made upon clinical signs and symptoms of local and systemic infection. Early multidisciplinary decision making is needed for optimal patient care. Repeated surgical wound debridements accompanied by wound conditioning are performed until clean circumstances are achieved. Thereafter, wound closure and defect reconstruction are obtained using a variety of pedicled and microvascular flaps.
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Affiliation(s)
- Yves Harder
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Ospedale Regionale di Lugano (ORL), Ente Ospedaliero Cantonale (EOC), Lugano, Schweiz.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Schweiz
| | - Johanna Krapf
- Universitätsklinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Medizinische Universität Innsbruck, Österreich
| | - Bernd Rieck
- Kaiser-Friedrich-Straße, Hildesheim, Deutschland
| | - Dirk J Schaefer
- Klinik für Plastische, Rekonstruktive, Ästhetische und Handchirurgie, Universitätsspital Basel, Schweiz
| | - Gabriel Djedovic
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Landekrankenhaus Feldkirch, Österreich
| | - Ingo Kutschka
- Klinik für Thorax-, Herz- und Gefäßchirurgie, Universitätsmedizin Göttingen, Deutschland
| | - Karolin Graf
- Zentralinstitut für Krankenhaushygiene, Paracelsus- Kliniken Deutschland, Langenhagen, Deutschland
| | - Ulrich Kneser
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Klinik für Plastische und Handchirurgie, Universität Heidelberg, Deutschland
| | - Raymund E Horch
- Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
| | - Marcus Lehnhardt
- Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, BG Universitätsklinikum Bergmannsheil Bochum, Deutschland
| | - Gerhard Pierer
- Universitätsklinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Medizinische Universität Innsbruck, Österreich
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