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Brown KGM, Solomon MJ. Topical haemostatic agents in surgery. Br J Surg 2024; 111:znad361. [PMID: 38156466 PMCID: PMC10771136 DOI: 10.1093/bjs/znad361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/15/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Kilian G M Brown
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Michael J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
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Sorm Z, Vobornik M, Dergel M, Cermakova E, Harrer J, Gofus J. Does bone wax make sense in off-pump coronary surgery? A prospective randomized study. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2023; 20:67-71. [PMID: 37564968 PMCID: PMC10410631 DOI: 10.5114/kitp.2023.129551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/18/2023] [Indexed: 08/12/2023]
Abstract
Introduction The effect of bone wax on sternal infection and intraoperative bleeding in off-pump coronary surgery has not been reported in current literature. Aim To prospectively evalute this in a cohort of high risk patients undergoing off-pump coronary artery surgery at our institution. The potential impact on cell saver utilization was also studied. Material and methods A prospective randomized study was performed in 58 diabetic patients operated on for two-vessel coronary artery disease by the off-pump technique. They were randomly assigned to the wax or no-wax group. Results There was no significant difference in intraoperative blood loss between the wax (550 ml) and no-wax group (750 ml; p = 0.0711). In multivariate analysis the absence (non-use) of bone wax (odds ratio = 3.9 (1.12-13.51), p = 0.027) and preoperative creatinin level (odds ratio = 1.1 (0.99-1.03), p = 0.03) were identified as independent predictors of blood loss ≥ 750 ml. The number of red blood cell units during hospital stay was similar in both groups (p = 0.42). Wound healing complications were not observed in either group. Conclusions The use of bone wax does not lead to a higher risk of sternal wound infection. It may reduce the risk of high intraoperative blood loss, thus avoiding the need of a cell saver during off-pump coronary surgery. However, this influence remains questionable.
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Affiliation(s)
- Zdenek Sorm
- Department of Cardiac Surgery, Charles University, Faculty of Medicine and University Hospital in Hradec Kralove, Czech Republic
| | - Martin Vobornik
- Department of Cardiac Surgery, Charles University, Faculty of Medicine and University Hospital in Hradec Kralove, Czech Republic
| | - Martin Dergel
- Department of Cardiac Surgery, Charles University, Faculty of Medicine and University Hospital in Hradec Kralove, Czech Republic
| | - Eva Cermakova
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
| | - Jan Harrer
- Department of Cardiac Surgery, Charles University, Faculty of Medicine and University Hospital in Hradec Kralove, Czech Republic
| | - Jan Gofus
- Department of Cardiac Surgery, Charles University, Faculty of Medicine and University Hospital in Hradec Kralove, Czech Republic
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Review of Biomechanical Studies and Finite Element Modeling of Sternal Closure Using Bio-Active Adhesives. Bioengineering (Basel) 2022; 9:bioengineering9050198. [PMID: 35621476 PMCID: PMC9138150 DOI: 10.3390/bioengineering9050198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022] Open
Abstract
The most common complication of median sternotomy surgery is sternum re-separation after sternal fixation, which leads to high rates of morbidity and mortality. The adhered sternal fixation technique comprises the wiring fixation technique and the use of bio-adhesives. Adhered sternal fixation techniques have not been extensively studied using finite element analysis, so mechanical testing studies and finite element analysis of sternal fixation will be presented in this review to find the optimum techniques for simulating sternal fixation with adhesives. The optimal wiring technique should enhance bone stability and limit sternal displacement. Bio-adhesives have been proposed to support sternal fixation, as wiring is prone to failure in cases of post-operative problems. The aim of this paper is to review and present the existing numerical and biomechanical sternal fixation studies by reviewing common sternal closure techniques, adhesives for sternal closure, biomechanical modeling of sternal fixation, and finite element modeling of sternal fixation systems. Investigating the physical behavior of 3D sternal fixation models by finite element analysis (FEA) will lower the expense of conducting clinical trials. This indicates that FEA studies of sternal fixation with adhesives are needed to analyze the efficiency of this sternal closure technique virtually.
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Basha MAA, Shemais DS, Abdelwahed ES, Elfwakhry RM, Zeid AF, Abdalla AAEHM, Aly SA, Abdelrahman DS, Elshenawy AA, Mansour W, Elbanna KAA, El Tahlawi M, Elnahal N. Computed Tomography Imaging Assessment of the Effect of Vancomycin Paste on Poststernotomy Healing. Int J Gen Med 2021; 14:9287-9296. [PMID: 34880667 PMCID: PMC8648099 DOI: 10.2147/ijgm.s343124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess vancomycin paste effect on poststernotomy healing in high-risk coronary artery bypass grafting (CABG) patients compared to bone wax using the 6-point computed tomography (CT) score. Additionally assessed the reliability of this score and its relationship to the occurrence of infection. Patients and Methods A prospective comparative analysis included 126 high-risk CABG patients. The patients were randomly assigned into bone wax or vancomycin paste for sternal haemostasis. All patients were submitted to CT examinations 6-months postoperative. Two radiologists independently reviewed all CT scans to assess sternal healing using the 6-point CT score. The CT healing score of the two groups was compared. The kappa statistics were used to calculate the inter-reader agreement (IRA) of the 6-point CT score. Results The final analysis included 61 patients in each group. The main CT score for sternal healing was 3.9±0.4 in the vancomycin group and 3.3±0.8 in the bone wax group. Patients in the vancomycin group had a higher statistically significant improvement in CT healing score than those in the bone wax group (p<0.001). There was no statistically significant relationship (p = 0.79) between the occurrence of infection and the 6-point CT score in the vancomycin group. The overall IRA of the 6-point CT score was good in two groups (κ = 0.79 in the vancomycin group and = 0.78 in the bone wax group). Conclusion Vancomycin paste had a better CT healing score and can be used as a sternal haemostatic material instead of bone wax. The 6-point CT healing score is a reliable diagnostic tool for evaluating sternal healing.
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Affiliation(s)
| | - Dina Said Shemais
- Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Essam Saad Abdelwahed
- Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Ayman Fathy Zeid
- Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Sameh Abdelaziz Aly
- Department of Radiodiagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
| | | | - Anwar A Elshenawy
- Department of Surgical Oncology, Faculty of Human Medicine, Aswan University, Aswan, Egypt
| | - Waleed Mansour
- Department of Chest Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Mohammad El Tahlawi
- Department of Cardiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nezar Elnahal
- Department of Cardiothoracic Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 508] [Impact Index Per Article: 169.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Surgical Treatment of Calcaneonavicular and Talocalcaneal Coalitions. Foot Ankle Clin 2021; 26:873-901. [PMID: 34752242 DOI: 10.1016/j.fcl.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Tarsal coalition is determined by an absence of segmentation between one or more foot bones. The main symptom is activity-related foot pain, usually dorsolateral for calcaneonavicular coalitions and medial for talocalcaneal ones. At presentation, a symptomatic tarsal coalition must be treated conservatively for at least 6 months. If the conservative treatment fails and the foot is still painful, resection is the treatment of choice. Advantage of surgery is to restore mobility and reduce the risk of subsequent degenerative arthritis. Common pitfalls of surgery include failure to recognize associated coalitions, inadequate or extensive resection, and injury of adjoining bones.
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Shu D, Li J, Zhao Y, Yang Y. Comparison of polyetheretherketone cables and stainless steel wires for sternal fixation after median sternotomy. J Int Med Res 2021; 49:3000605211041265. [PMID: 34551599 PMCID: PMC8485305 DOI: 10.1177/03000605211041265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective To compare the sternal fixation effect of a polyetheretherketone (PEEK) cable product and stainless steel wire after median sternotomy. Methods A multicentre retrospective clinical trial was conducted in patients that underwent median sternotomy for a range of surgical reasons. The sternum was fixed using PEEK sternal cables in the experimental group and stainless steel wires in the control group. The general patient state, product manoeuvrability, bone and wound healing state and blood test results were evaluated at seven visits during the preoperative, surgical and follow-up periods. Results A total of 108 patients (54 in each group) were included in the analysis at the final 180-day follow-up. The sternum was successfully closed using PEEK cables or steel wires in all patients and all healed well. No pathological changes were found on the X-ray imaging. Computed tomography imaging confirmed ideal fracture healing. No significant difference was found between the experimental group and the control group in outcomes. Conclusion PEEK cables are easy to implant and show desirable effectiveness in sternal fixation without any observed side-effects.
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Affiliation(s)
- Duanchao Shu
- Department of Cardiovascular Surgery, Baoji Municipal Central Hospital, Baoji, Shaanxi Province, China
| | - Jianpeng Li
- Department of Cardiovascular Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yixin Zhao
- Department of Neurology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yan Yang
- Department of Cardiovascular Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
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Kolz JM, Alvi MA, Bhatti AR, Tomov MN, Bydon M, Sebastian AS, Elder BD, Nassr AN, Fogelson JL, Currier BL, Freedman BA. Anterior Cervical Osteophyte Resection for Treatment of Dysphagia. Global Spine J 2021; 11:488-499. [PMID: 32779946 PMCID: PMC8119911 DOI: 10.1177/2192568220912706] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVES When anterior cervical osteophytes become large enough, they may cause dysphagia. There is a paucity of work examining outcomes and complications of anterior cervical osteophyte resection for dysphagia. METHODS Retrospective review identified 19 patients who underwent anterior cervical osteophyte resection for a diagnosis of dysphagia. The mean age was 71 years and follow-up, 4.7 years. The most common level operated on was C3-C4 (13, 69%). RESULTS Following anterior cervical osteophyte resection, 79% of patients had improvement in dysphagia. Five patients underwent cervical fusion; there were no episodes of delayed or iatrogenic instability requiring fusion. Fusion patients were younger (64 vs 71 years, P = .05) and had longer operative times (315 vs 121 minutes, P = .01). Age of 75 years or less trended toward improvement in dysphagia (P = .09; OR = 18.8; 95% CI 0.7-478.0), whereas severe dysphagia trended toward increased complications (P = .07; OR = 11.3; 95% CI = 0.8-158.5). Body mass index, use of an exposure surgeon, diffuse idiopathic skeletal hyperostosis diagnosis, surgery at 3 or more levels, prior neck surgery, and fusion were not predictive of improvement or complication. CONCLUSIONS Anterior cervical osteophyte resection improves swallowing function in the majority of patients with symptomatic osteophytes. Spinal fusion can be added to address stenosis and other underlying cervical disease and help prevent osteophyte recurrence, whereas intraoperative navigation can be used to ensure complete osteophyte resection without breaching the cortex or entering the disc space. Because of the relatively high complication rate, patients should undergo thorough multidisciplinary workup with swallow evaluation to confirm that anterior cervical osteophytes are the primary cause of dysphagia prior to surgery.
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Affiliation(s)
- Joshua M. Kolz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Atiq R. Bhatti
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Marko N. Tomov
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ahmad N. Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Brett A. Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Brett A. Freedman, Department of Orthopedic
Surgery, Mayo Clinic Minnesota, 200 First St SW, Rochester, MN 55905, USA.
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Topical hemostatic agents from an oral-surgery perspective. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2021. [DOI: 10.1016/j.ajoms.2020.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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11
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Amal I, Soebroto H, Puruhito. Comparison of bone wax and chitosan usage on post-sternotomy bone healing. Asian Cardiovasc Thorac Ann 2020; 29:203-207. [PMID: 33353370 DOI: 10.1177/0218492320984097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Sternotomy is a standard approach performed in almost every surgical procedure on the heart and mediastinum. Effective hemostasis of the sternum is required to keep the operative field dry, avoid excessive blood transfusions during surgery, and prevent reoperation due to massive postoperative bleeding, which can further increase morbidity and mortality in patients. Bone wax is a mechanical hemostat commonly used after sternotomy and has been known to affect bone healing, trigger chronic inflammatory reactions, and increase the rate of infection. The application of chitosan, which has intrinsic hemostat ability, as hemostatic material is believed to improve bone healing following sternotomy. This study aimed to compare the effectiveness of bone wax and chitosan on bone healing after sternotomy. METHODS Median sternotomies were performed on 2 groups of New Zealand White rabbits. Each group of 16 animals received either bone wax or chitosan powder as hemostatic material. The degree of bone healing, the number of foreign-body giant cells, and the number of osteoblasts were evaluated after 6 weeks. RESULTS Radiographs showed that significantly more animals in the chitosan group had total sternal healing (p = 0.033). Histopathology revealed that the number of foreign-body giant cells was significantly less (p = 0.036) and the number of osteoblasts was significantly greater (p < 0.0001) in the group of animals that received chitosan. CONCLUSION The use of chitosan as hemostatic material can promote better bone healing compared to bone wax.
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Affiliation(s)
- Ihsanul Amal
- Department of Thoracic, Cardiac, and Vascular Surgery, Soetomo General Hospital, Airlangga University, Surabaya, East Java, Indonesia
| | - Heroe Soebroto
- Department of Thoracic, Cardiac, and Vascular Surgery, Soetomo General Hospital, Airlangga University, Surabaya, East Java, Indonesia
| | - Puruhito
- Department of Thoracic, Cardiac, and Vascular Surgery, Soetomo General Hospital, Airlangga University, Surabaya, East Java, Indonesia
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Recent advancement and development of chitin and chitosan-based nanocomposite for drug delivery: Critical approach to clinical research. ARAB J CHEM 2020. [DOI: 10.1016/j.arabjc.2020.10.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Pradeep A, Rangasamy J, Varma PK. Recent developments in controlling sternal wound infection after cardiac surgery and measures to enhance sternal healing. Med Res Rev 2020; 41:709-724. [PMID: 33174619 DOI: 10.1002/med.21758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/22/2020] [Accepted: 11/02/2020] [Indexed: 01/25/2023]
Abstract
One of the major risks of cardiac surgery is the occurrence of infection at the sternal wound site. Sternal wound infections are primarily classified into superficial infection and deep sternal wound infection or mediastinitis. A patient is diagnosed with mediastinitis if microorganisms are present in their mediastinal tissue/fluid or with the observation of sternal wound infection during operation and with characteristic symptoms including chest pain, fever, and purulent drainage from the mediastinum. It is usually caused by Staphylococcal organisms in 75.8% of cases and the rest is caused by gram-negative bacteria. Currently, in cardiac surgery, hemostasis is achieved using electrocautery and bone wax, and the sternum is closed using wire cerclage. Several studies show that bone wax can act as a nidus for initiation of infection and the oozing blood and hematoma at the site can promote the growth of infectious organisms. Many research groups have developed different types of biomaterials and reported on the prevention of infection and healing of the sternum. These materials are reported to have both positive and negative effects. In this review, we highlight the current clinical practices undertaken to prevent infection and bleeding as well as research progress in this field and their outcomes in controlling bleeding, infection, and enhancing sternal healing.
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Affiliation(s)
- Aathira Pradeep
- Centre for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Jayakumar Rangasamy
- Centre for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Praveen Kerala Varma
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
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Zia A, Hasan M, Ilyas S, Siddiqui HU, Tappuni B, Marsia S, Zubair MM, Raza S, Mustafa RR, Baloch ZQ, Deo SV, Sharma UM, Sheikh MA. Reining in Sternal Wound Infections: The Achilles' Heel of Bilateral Internal Thoracic Artery Grafting. Surg Infect (Larchmt) 2020; 21:323-331. [DOI: 10.1089/sur.2018.142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Aisha Zia
- Department of Thoracic & Cardiovascular Surgery, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marium Hasan
- Department of Urology, The Kidney Centre, Karachi, Pakistan
| | - Sidra Ilyas
- Department of Medicine, Detroit Medical Center/Wayne State University, Detroit, Michigan, USA
| | - Hafiz Umair Siddiqui
- Department of Thoracic & Cardiovascular Surgery, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bassman Tappuni
- Department of Thoracic & Cardiovascular Surgery, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shayan Marsia
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - M. Mujeeb Zubair
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Sajjad Raza
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Rami R. Mustafa
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Salil V. Deo
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Umesh M. Sharma
- Community Division of Hospital Medicine, Mayo Clinic Health System, Rochester, Minnesota, USA
| | - Mohammad Adil Sheikh
- Department of Medicine, Detroit Medical Center/Wayne State University, Detroit, Michigan, USA
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15
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Jackson N, Assad M, Vollmer D, Stanley J, Chagnon M. Histopathological Evaluation of Orthopedic Medical Devices: The State-of-the-art in Animal Models, Imaging, and Histomorphometry Techniques. Toxicol Pathol 2019; 47:280-296. [DOI: 10.1177/0192623318821083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Orthopedic medical devices are continuously evolving for the latest clinical indications in craniomaxillofacial, spine, trauma, joint arthroplasty, sports medicine, and soft tissue regeneration fields, with a variety of materials from new metallic alloys and ceramics to composite polymers, bioresorbables, or surface-treated implants. There is great need for qualified medical device pathologists to evaluate these next generation biomaterials, with improved biocompatibility and bioactivity for orthopedic applications, and a broad range of knowledge is required to stay abreast of this ever-changing field. Orthopedic implants require specialized imaging and processing techniques to fully evaluate the bone-implant interface, and the pathologist plays an important role in determining the proper combination of histologic processing and staining for quality slide production based on research and development trials and validation. Additionally, histomorphometry is an essential part of the analysis to quantify tissue integration and residual biomaterials. In this article, an overview of orthopedic implants and animal models, as well as pertinent insights for tissue collection, imaging, processing, and slide generation will be provided with a special focus on histopathology and histomorphometry evaluation.
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Affiliation(s)
| | - Michel Assad
- AccelLAB Inc., A Citoxlab Company, Boisbriand, Quebec, Canada
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16
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Fibrin-Coated Collagen Fleece Seems to Prevent Sternal Instability after Cardiac Surgery: A Matched Pair Data Analysis. Thorac Cardiovasc Surg 2018; 68:737-742. [PMID: 30153697 DOI: 10.1055/s-0038-1667326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND To examine if fibrin-coated collagen fleece (Tachosil) interferes with bone and wound healing when it is used on the cut surface of the sternum after median sternotomy. METHODS A total of 25 patients with osteoporotic sternal disorders were treated with fibrin-coated collagen fleece at the cut surface of the sternum after median sternotomy (therapy group). We compared the occurrence of impaired wound healing and sternal instability, reoperation rate, and 30-day mortality with a control group of 25 case-matched patients. After matching for age, gender, and risk factors for sternal instability (diabetes mellitus, osteoporosis, body mass index, nicotine consumption), both groups were comparable. RESULTS Sternal instability occurred in one (4%) patient in the study group and in five (20%) patients in the control group. Impaired wound healing occurred in one (4%) patient in the therapy group and two (8%) patients in the control group. Reoperation was necessary in four (16%) patients in the therapy group and 6 (24%) patients in the control group. The 30-day mortality occurred in six (24%) patients in the therapy group and four (16%) patients in the control group. CONCLUSIONS The use of fibrin-coated collagen fleece on the cut surface of the sternum in patients with osteoporosis does not impair bone and wound healing. Furthermore, it seems to result in less sternal instability. A larger prospective study is necessary to verify the results of this explorative study.
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Capek L, Henys P, Kalab M, Solfronk P. Failure of sternal wires depends on the number of turns and plastic deformation: combined experimental and computational approach. Interact Cardiovasc Thorac Surg 2018; 26:777-782. [PMID: 29325026 DOI: 10.1093/icvts/ivx425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/29/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The number of turns at the end of a wire closure is not described or discussed in any cardiosurgical guidelines. The hands-on experience of the surgeon plays a significant role. The aim of this work was to clarify the relationship between the number of turns of the suture and the resulting strength of the sternal fixation. METHODS The study was performed in 2 independent steps. The first step was a finite element simulation, where the stress and strain distribution of the sternal fixation was observed. The second step included the experimental set-up and the statistical evaluation of the results. RESULTS Our study showed that the failure force rose linearly as the number of turns increased. The lowest average measured force was 370 N (3 turns); the highest was 430 N (7 turns). The failure modes were either untwisting of the wires or rupture of the closure, which is controlled by the number of turns. As the number of turns increases, superficial cracks can occur. CONCLUSIONS Based on our results, the 5-turn option is the best solution for the closure. The failure force is still double the value reported in the literature, so there is a high safety margin for failure. The failure mode is untwisting; hence, no unexpected fracture can occur, and there is still an elastic core in the cross-section of the wire.
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Affiliation(s)
- Lukas Capek
- Department of Technologies and Structures, Technical University of Liberec, Liberec, Czech Republic
| | - Petr Henys
- Department of Technologies and Structures, Technical University of Liberec, Liberec, Czech Republic
| | - Martin Kalab
- Faculty of Medicine and Dentistry, Department of Cardiosurgery, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Pavel Solfronk
- Department of Engineering Technology, Technical University of Liberec, Liberec, Czech Republic
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Fat Graft and Bone Wax Interposition Provides Better Functional Outcomes and Lower Reossification Rates Than Extensor Digitorum Brevis After Calcaneonavicular Coalition Resection. J Pediatr Orthop 2018; 37:e427-e431. [PMID: 28777279 DOI: 10.1097/bpo.0000000000001061] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Calcaneonavicular coalitions are the most common form of tarsal coalitions. The prefered treatment for symptomatic coalitions is surgical resection; however, there are no published studies that directly compare different interposition techniques. The purpose of the present study was to retrospectively compare pain relief, functional outcomes, and complications of children and adolescents who had a resection of a symptomatic calcaneonavicular coalition with interposition of fat graft, bone wax, or extensor digitorum brevis (EDB). METHODS In total, 48 patients (56 ft) underwent calcaneonavicular coalition resection-interposition at 3 institutions from July 2008 to July 2015. There were 23 feet in group 1 (fat graft), 18 feet in group 2 (bone wax), and 15 feet in group 3 (EDB). Patient demographic characteristics were similar between all groups for age, sex, coalition type, and symptoms onset. Data concerning clinical and radiographic features, surgical technique, and postoperative complications were obtained from all available medical records. Radiographs were evaluated at last follow-up to determine coalition regrowth. Preoperative and postoperative pain was assessed with the visual analog scale, and function was assessed with use of the American-Orthopaedic-Foot and Ankle Society (AOFAS) score. RESULTS Pain improved to an average of 0.5 in the first group (range, 0 to 6), 0 in group 2, and 1.7 in group 3 (range, 0 to 5) (P=0.033). The average AOFAS score improved from 59 (range, 33 to 71 points) to 98 points (range, 62 to 100 points) in the fat graft group, from 50 (range, 34 to 62 points) to 98 points (range, 88 to 100 points) in the bone wax group, and from 48 (range, 30 to 60 points) to 75 points (range, 70 to 95 points) in the EDB group (P<0.001). Eight feet had regrowth of the coalition on the postoperative radiographs: 1 in group 1 (4%), 1 in group 2 (6%), and 6 in group 3 (40%) (P=0.004). Five feet from the third group developed progressive symptoms. CONCLUSIONS In our study, autogenous fat graft and bone wax interposition techniques provided better pain relief, gave better functional scores, and avoided more effectively coalition reossification than EDB technique. Further studies are required to evaluate safety of bone wax as an interposition material. LEVEL OF EVIDENCE Level III-therapeutic.
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Novel Sternal Protection Device for Cardiac Surgery Via Median Sternotomy Incision. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:370-374. [PMID: 29023352 PMCID: PMC5657466 DOI: 10.1097/imi.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental digital content is available in the text. Objective Sternal bleeding during cardiac surgery is currently controlled using bone wax or other chemical substances that may result in adverse effects and affect wound healing and recovery. The purpose of this study was to identify a safe, cost-effective, and easy-to-use technique to reduce sternal bleeding and sternal trauma during cardiac surgery. Methods After sternotomy, a sternal protection device was placed over each hemisternal section before insertion of the retractor and remained in situ until the end of surgery. Sternal bleeding and ease of use were assessed and recorded during surgery. Sternal trauma was assessed and recorded within 5 minutes of removal of the device, and overall satisfaction (Global Impression) and any intraoperative adverse events or device malfunction were reported at surgery completion. Patients were followed up 24 hours and 4 weeks after surgery. Results Twelve patients completed the study. Adverse events reported were not considered related to the device. No sternal trauma was identified in any patient. In 9 of 11 patients, sternal bleeding was reduced after insertion of the device. The device was generally considered easy to use, although some difficulty was encountered when used with the Internal Mammary Artery retractor. Conclusions Our data suggest that the device is safe and able to reduce sternal bleeding during surgery using sternal retractors. We recommend further studies in a larger population of patients with a control group to evaluate the device's ability to reduce the morbidity associated with sternal bleeding and sternal trauma.
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Marasco SF, McGiffin DC, Zimmet AD, Soils PC, Bingham JM, Moshinsky RA. Novel Sternal Protection Device for Cardiac Surgery via Median Sternotomy Incision. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Silvana F. Marasco
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - David C. McGiffin
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - Adam D. Zimmet
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | | | | | - Randall A. Moshinsky
- Department of Cardiothoracic Surgery, Monash Health, Clayton, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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Gurcan O, Gurcay AG, Kazanci A, Onder E, Senturk S, Bavbek M. Is the use of hemostatic matrix (Floseal) and alkylene oxide copolymer (Ostene) safe in spinal laminectomies? Peridural fibrosis assessment. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:165-168. [PMID: 28246047 PMCID: PMC6197407 DOI: 10.1016/j.aott.2017.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/26/2016] [Accepted: 06/10/2016] [Indexed: 02/09/2023]
Abstract
Objective Failed Back Syndrome (FBS) is unacceptable relief of pain or recurrence of symptoms in patients after spinal surgery, such as laminectomy. One possible cause of FBS is peridural fibrosis (PF). PF is the overproduction of scar tissue adjacent to the dura mater. Bleeding can cause PF after laminectomy. Ostene is an alkylene oxide copolymer material used to stop bleeding from bony surfaces. Floseal is a gelatin thrombin matrix sealant used to assist fibrin formation and to promote coagulation. Methods Total of 32 female Sprague–Dawley rats were evenly allotted to 4 experimental groups: laminectomy only, laminectomy + Ostene (Baxter International, Inc., Deerfield, IL, USA), laminectomy + Floseal (Baxter International, Inc., Deerfield, IL, USA), and laminectomy + Adcon-L (aap Implantate AG, Berlin, Germany). After performing total laminectomy, agents were placed over dura mater. Spinal column of test subjects was harvested 6 weeks after laminectomy. Histopathological examination of samples was based on Masson's trichrome and hematoxylin and eosin staining. PF observed in the groups was graded using system previously described by He et al. Statistically significant p value was defined as p < 0.005. Results Present study revealed that Adcon-L, Ostene, and Floseal groups had reduced PF compared with laminectomy only group (p = 0.001). Comparison of Ostene and Floseal groups with Adcon-L group yielded no significant difference. Conclusion Reoperation as result of FBS has greater risk and often has poor outcome; surgeons must take precautions to avoid FBS, such as careful selection of appropriate patient and operation technique. Ostene and Floseal may be applied and left in the operation field safely during laminectomy to reduce occurrence of PF after procedure.
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A Randomized Trial to Assess the Contribution of a Novel Thorax Support Vest (Corset) in Preventing Mechanical Complications of Median Sternotomy. Cardiol Ther 2016; 6:41-51. [PMID: 27995554 PMCID: PMC5446811 DOI: 10.1007/s40119-016-0078-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Indexed: 11/07/2022] Open
Abstract
Objectives Mechanical complications of median sternotomy may cause significant morbidity and mortality in cardiac surgical patients. This study was aimed at assessing the role of Posthorax support vest (Epple, Inc., Vienna, Austria) in the prevention of sternal complications and the improvement of anatomical healing in patients at high risk for mechanical sternal dehiscence after cardiac surgery by mean of median sternotomy. Methods A prospective, randomized, study was performed and 310 patients with predisposing factors for sternal dehiscence after sternotomy for cardiac surgery were included. The patients were divided into two groups: patients who received the Posthorax support vest after surgery, and patients who did not. Primary variables assessed included the incidence of mechanical sternal complications, the quality of sternal healing, the rate of re-operation, the duration of hospitalization, rate and duration of hospital, re-admission for sternal complications. Secondary variables assessed were the post-operative pain, the number of requests for supplemental analgesia and the quality of life measured by means of the EQ-5D format. Results Patients using vest demonstrated a lower incidence of mechanical sternal complications, a better anatomical sternum healing, lower hospital stay, no re-operations for sternal dehiscence before discharge and lower re-admissions for mechanical sternal complication. In addition, patients using a vest reported a better quality of life with better freedom from limitations in mobility, self-care, and pain. Conclusions Our findings demonstrate that the use of the Posthorax vest reduces post-sternotomy mechanical complications and improves the healing of the sternotomy, the clinical course, and the post-operative quality of life.
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Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S. Prevention and management of sternal wound infections. J Thorac Cardiovasc Surg 2016; 152:962-72. [PMID: 27555340 DOI: 10.1016/j.jtcvs.2016.01.060] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/01/2015] [Accepted: 01/12/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Harold L Lazar
- Division of Cardiac Surgery, Boston Medical Center, Boston, Mass.
| | - Thomas Vander Salm
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Richard Engelman
- Division of Cardiac Surgery, Baystate Medical Center, Springfield, Mass
| | - Dennis Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Steven Gordon
- Division of Infectious Diseases, The Cleveland Clinic, Cleveland, Ohio
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Chernyavsky AM, Tarkova AR, Ruzmatov TM, Morozov SV, Grigoriev IA. [Infections in cardiac surgery]. Khirurgiia (Mosk) 2016:64-68. [PMID: 27447005 DOI: 10.17116/hirurgia2016564-68] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- A M Chernyavsky
- Academician E.N. Meshalkin Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation
| | - A R Tarkova
- Academician E.N. Meshalkin Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation
| | - T M Ruzmatov
- Academician E.N. Meshalkin Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation
| | - S V Morozov
- N.N. Vorozhtsov Novosibirsk Institute of Organic Chemistry, Siberian Department of RAS, Russia
| | - I A Grigoriev
- N.N. Vorozhtsov Novosibirsk Institute of Organic Chemistry, Siberian Department of RAS, Russia
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Gudbjartsson T, Jeppsson A, Sjögren J, Steingrimsson S, Geirsson A, Friberg O, Dunning J. Sternal wound infections following open heart surgery – a review. SCAND CARDIOVASC J 2016; 50:341-348. [DOI: 10.1080/14017431.2016.1180427] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden
| | - Steinn Steingrimsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Arnar Geirsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Orjan Friberg
- Department of Cardiothoracic Surgery, Orebro University Hospital, Orebro, Sweden
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
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Chen YR, Sung K, Tharin S. Symptomatic Anterior Cervical Osteophyte Causing Dysphagia: Case Report, Imaging, and Review of the Literature. Cureus 2016; 8:e473. [PMID: 27004150 PMCID: PMC4779080 DOI: 10.7759/cureus.473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Anterior cervical osteophytes are found in 20-30% of elderly patients. Rarely, severe osteophytes can cause dysphagia, dysphonia, and dyspnea. Here, we illustrate a case of severe dysphagia caused by a large post-traumatic osteophyte with oropharyngeal swallow study showing a significant mass effect on the pharynx and resolution following osteophytectomy. We also review the literature regarding the etiology, diagnosis, and treatment of symptomatic anterior cervical osteophytes.
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Affiliation(s)
- Yi-Ren Chen
- Department of Neurosurgery, Stanford University School of Medicine
| | - Kwang Sung
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine
| | - Suzanne Tharin
- Department of Neurosurgery, Stanford University School of Medicine
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Hwang NC. Preventive Strategies for Minimizing Hemodilution in the Cardiac Surgery Patient During Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2015; 29:1663-71. [DOI: 10.1053/j.jvca.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Indexed: 11/11/2022]
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The Influence of Hemostatic Agents on Bone Healing After Sternotomy in a Porcine Model. Ann Thorac Surg 2015; 99:1005-11. [DOI: 10.1016/j.athoracsur.2014.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 10/03/2014] [Accepted: 10/07/2014] [Indexed: 11/23/2022]
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Shin YC, Kim SH, Kim DJ, Kim DJ, Kim JS, Lim C, Park KH. Sternal healing after coronary artery bypass grafting using bilateral internal thoracic arteries: assessment by computed tomography scan. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:33-9. [PMID: 25705595 PMCID: PMC4333848 DOI: 10.5090/kjtcs.2015.48.1.33] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 09/24/2014] [Accepted: 10/02/2014] [Indexed: 11/26/2022]
Abstract
Background This study aimed to investigate sternal healing over time and the incidence of poor sternal healing in patients undergoing coronary artery bypass graft (CABG) surgery using bilateral internal thoracic arteries. Methods This study enrolled 197 patients who underwent isolated CABG using skeletonized bilateral internal thoracic arteries (sBITA) from 2006 through 2009. Postoperative computed tomography (CT) angiography was performed on all patients at monthly intervals for three to six months after surgery. In 108 patients, an additional CT study was performed 24 to 48 months after surgery. The axial CT images were used to score sternal fusion at the manubrium, the upper sternum, and the lower sternum. These scores were added to evaluate overall healing: a score of 0 to 1 reflected poor healing, a score of 2 to 4 was defined as fair healing, and a score of 5 to 6 indicated complete healing. Medical records were also retrospectively reviewed to identify perioperative variables associated with poor early sternal healing. Results Three to six months after surgery, the average total score of sternal healing was 2.07±1.52 and 68 patients (34.5%) showed poor healing. Poor healing was most frequently found in the manubrium, which was scored as zero in 72.6% of patients. In multivariate analysis, the factors associated with poor early healing were shorter post-surgery time, older age, diabetes mellitus, and postoperative renal dysfunction. In later CT images, the average sternal healing score improved to 5.88±0.38 and complete healing was observed in 98.2% of patients. Conclusion Complete sternal healing takes more than three months after a median sternotomy for CABG using sBITA. Healing is most delayed in the manubrium.
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Affiliation(s)
- Yoon Cheol Shin
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Sue Hyun Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Dong Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Dong Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital
| | - Jun Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
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Andelius TC, Vestergaard RF, Hauge EM, Bruel A, Thomsen JS, Honge JL, Hjortdal VE. The effect of haemostatic devices on bone healing 6 months postoperatively in sternotomized pigs. Eur J Cardiothorac Surg 2015; 48:850-4. [DOI: 10.1093/ejcts/ezu528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/11/2014] [Indexed: 11/12/2022] Open
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Biodegradable composite scaffolds of bioactive glass/chitosan/carboxymethyl cellulose for hemostatic and bone regeneration. Biotechnol Lett 2014; 37:457-65. [PMID: 25326173 DOI: 10.1007/s10529-014-1697-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
Abstract
Hemostasis in orthopedic osteotomy or bone cutting requires different methods and materials. The bleeding of bone marrow can be mostly stopped by bone wax. However, the wax cannot be absorbed, which leads to artificial prosthesis loosening, foreign matter reaction, and infection. Here, a bioactive glass/chitosan/carboxymethyl cellulose (BG/CS/CMC) composite scaffold was designed to replace traditional wax. WST-1 assay indicated the BG/CS/CMC composite resulted in excellent biocompatibility with no cytotoxicity. In vivo osteogenesis assessment revealed that the BG/CS/CMC composite played a dominant role in bone regeneration and hemostasis. The BG/CS/CMC composite had the same hemostasis effect as bone wax; in addition its biodegradation also led to the functional reconstruction of bone defects. Thus, BG/CS/CMC scaffolds can serve as a potential material for bone repair and hemostasis in critical-sized bone defects.
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Suwanprateeb J, Kiertkrittikhoon S, Kintarak J, Suvannapruk W, Thammarakcharoen F, Rukskul P. In vivo assessment of new resorbable PEG-PPG-PEG copolymer/starch bone wax in bone healing and tissue reaction of bone defect in rabbit model. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:2131-2139. [PMID: 24913421 DOI: 10.1007/s10856-014-5249-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/26/2014] [Indexed: 06/03/2023]
Abstract
In this study, in vivo performance of novel resorbable bone wax based on a miscible blend between PEG-PPG-PEG copolymer mixtures and pregelatinized starch at 0 and 25 percent by weight including hemostasis, tissue reaction and bone healing in a non-critical size tibia defect model were assessed and compared with commercial non-resorbable bone wax. Systemic reaction was evaluated by blood chemistry while local reaction, bone quantity and quality were evaluated by microcomputed tomography (microCT) and histology analyses. It was observed that the resorbable bone waxes did not show any adverse systemic reaction and resorbed from the defects within approximately 2 days after application. They were as effective as the commercial bone wax in hemostasis, but provided better adherence to the bone surface. The incorporation of pre-gelatinized starch in the formulation could further help in improved molding texture and decreased glove adherence. MicroCT and histology analyses showed that the resorbable bone waxes did not inhibit the osteogenesis whereas commercial bone wax impaired bone healing and displayed inflammation and foreign body reactions.
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Affiliation(s)
- J Suwanprateeb
- National Metal and Materials Technology Center (MTEC), National Science and Technology Development Agency, Ministry of Science and Technology, 114 Paholyothin Road, Klong 1, Klongluang, Pathumthani, 12120, Thailand,
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Effect of Hemostatic Material on Sternal Healing After Cardiac Surgery. Ann Thorac Surg 2014; 97:153-60. [DOI: 10.1016/j.athoracsur.2013.08.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 08/07/2013] [Accepted: 08/13/2013] [Indexed: 11/17/2022]
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Suwanprateeb J, Suvannapruk W, Thammarakcharoen F, Chokevivat W, Rukskul P. Preparation and characterization of PEG-PPG-PEG copolymer/pregelatinized starch blends for use as resorbable bone hemostatic wax. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2013; 24:2881-2888. [PMID: 23955721 DOI: 10.1007/s10856-013-5027-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 07/29/2013] [Indexed: 06/02/2023]
Abstract
In this study, polymer blends between PEG-PPG-PEG copolymer mixtures and pregelatinized starch at various compositions ranging from 0 to 3 % by weight were prepared and evaluated for potential use as novel resorbable bone hemostatic wax. It was found that the prepared samples had sufficient smearability for use as a bone wax. An addition of pregelatinized starch increased the hardness, smoothness and consistency of the texture while decreasing the adherence to glove. Thermal analysis indicated that the heat of fusion slightly decreased with increasing pregelatinized starch content. Compressive stiffness tended to decrease with increasing starch content for concentrations lower than 20 %, but re-increased at higher starch levels. In contrast, adherence deformation increased initially, but then decreased with increasing starch content. This behavior was related to the dependence of softening or reinforcing effect on the level of starch concentration in the samples. Adherence load and energy decreased with the addition of pregelatinized starch implying the decrease in adhesiveness of the samples. Furthermore, increasing the pregelatized starch amount also increased the liquid sealing duration of the samples at both 23 and 37 °C. Cytotoxicity tests against osteoblasts using a MTT assay revealed that the all the prepared samples and their raw materials did not show any cytotoxic potential. Formulations containing pregelatinized starch content between 20 and 30 % were found to show optimized performance.
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Affiliation(s)
- J Suwanprateeb
- National Metal and Materials Technology Center (MTEC), National Science and Technology Development Agency (NSTDA), 114 Paholyothin Road, Klong 1, Klongluang, Pathumthani, 12120, Thailand,
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Howe N, Cherpelis B. Obtaining rapid and effective hemostasis. J Am Acad Dermatol 2013; 69:659.e1-659.e17. [DOI: 10.1016/j.jaad.2013.07.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/01/2013] [Accepted: 07/09/2013] [Indexed: 11/25/2022]
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Madsboell TK, Vestergaard RF, Andelius TC, Hauge EM, Hasenkam JM. Gentamicin-enriched, water-soluble polymer wax reduces the burden of infection after sternotomy in pigs. Eur J Cardiothorac Surg 2013; 45:476-80. [DOI: 10.1093/ejcts/ezt410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Simman R, Reynolds D, Saad S. Bedside bleeding control, review paper and proposed algorithm. J Am Coll Clin Wound Spec 2013; 4:40-4. [PMID: 24527382 DOI: 10.1016/j.jccw.2013.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 06/16/2013] [Accepted: 06/16/2013] [Indexed: 10/26/2022] Open
Abstract
Bleeding is a common occurrence in practice, but occasionally it may be challenging issue to overcome. It can come from numerous sources such as, trauma, during or post-surgical intervention, disorders of platelet and coagulation factors and increased fibrinolysis, wounds and cancers. This paper was inspired from our experience with a patient admitted to a local long term acute care facility with a large fungating right breast cancerous wound. During her hospital stay spontaneous bleeding from her breast cancerous mass was encountered and became more frequent and significant over the period of her stay. Different hemostatic technologies were used to control her bleeding. We felt that it was important to share our experience with our colleagues to help with potential similar situation that they may face.
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Affiliation(s)
- Richard Simman
- Division of Plastic and Reconstructive Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA ; Department of Pharmacology and Toxicology, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - David Reynolds
- Podiatric Medicine and Surgery Residency, Dayton VA Medical Center, 4100 W. Third St., Dayton, OH 45428, USA
| | - Sharon Saad
- Intern Observership at Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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Solomon LB, Guevara C, Büchler L, Howie DW, Byard RW, Beck M. Does bone wax induce a chronic inflammatory articular reaction? Clin Orthop Relat Res 2012; 470:3207-12. [PMID: 22760602 PMCID: PMC3462874 DOI: 10.1007/s11999-012-2457-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 06/18/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone wax is used to control femoral neck bleeding during open femoroacetabular impingement (FAI) surgery. Despite its widespread use, only a few case reports and small case series describe side effects after extraarticular use. It is unclear whether intraarticular use of bone wax leads to such complications. However, during revision FAI surgery, we have observed various degrees of articular inflammatory reactions. QUESTIONS/PURPOSES We therefore investigated whether the bone wax used intraarticularly to control femoral neck bleeding during FAI surgery could be associated with the inflammatory reactions observed at revision surgery. METHODS We visually inspected the area and analyzed biopsy specimens from all 14 patients undergoing revision surgery from March 2005 to March 2006, 11 of whom had bone wax used at the time of original surgery. The three patients who did not have bone wax were used as controls. RESULTS Bone wax was identified macroscopically on the femoral neck at the time of the revision surgery in all 11 patients. In all 11 patients, biopsy results indicated a foreign body-type chronic synovial inflammation. Five patients also had an associated synovial lymphoplasmacytic inflammatory reaction. No inflammatory reaction was observed in the biopsy specimens obtained from the three patients in whom bone wax was not originally used. CONCLUSIONS Our findings suggest a synovial foreign body reaction, with or without an associated lymphoplasmacytic chronic inflammatory reaction, may be associated with intraarticular use of bone wax.
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Affiliation(s)
- Lucian B Solomon
- Discipline of Orthopaedics and Trauma, The University of Adelaide, North Terrace, South Adelaide 5000, Australia.
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