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At least 631 records · Page 35Linked to original sources
PubMed1994

[Reoperations for valvular heart disease through repeated median sternotomy incision].

One thousand and three hundred patients underwent open heart surgery for acquired valvular diseases in our hospital from 1952 through December 1993. There were 105 reoperative cases through repeated median sternotomy incision and 52 cases of prosthetic valve replacement by the same operator in the last 5 years. We studied technical procedures by these reoperative experience. There was only one case (1.9%) of hospital death in replacement cases. We believe that repeated open heart surgery for acquired valvular diseases should be done prior to deterioration of patient's clinical condition. We had to pay attention to facilitate mobilization of right atrium and aortic root in the aortic and mitral valvular reoperations. To decrease operative mortality of prosthetic valve replacement, each operative techniques were necessary by the reasons for reoperation.

Adolescent↗
PubMed1994

[Advantages of lung surgery via medial sternotomy and use of extracorporeal circulation in very advanced lung tumors].

The authors present their initial experience with surgery of pulmonary affections in 32 patients where they used medial sternotomy as the route of approach. They provide evidence of the advantages of this approach, in particular in high-risk patients, and of the favourable effect of this approach on the postoperative course. Successful radical surgery under conditions of extracorporeal circulation, although a very advanced tumour was involved where posterolateral thoracotomy was unequivocally contraindicated, indicates that there is a possibility to extend indications of surgical therapy of otherwise inoperable pulmonary tumours.

Extracorporeal Circulation↗
PubMed1993

[Post-sternotomy mediastinitis treated by omental transposition].

Mediastinitis after cardiac surgery is a serious complication with high morbidity and mortality rates. Between December 1989 and April 1992, of 264 patients who underwent cardiac or aortic surgery with median sternotomy, seven (2.6%) developed deep sternal infections with mediastinitis. Six of these patients were treated with debridement, irrigation and delayed wound closure with mediastinal transposition of the greater omentum. Most of the infections were associated with several predisposing factors: cardiac cachexia in the preoperative state, prolonged perfusion time, and respiratory insufficiency in the postoperative period. One of the six patients died of adult respiratory distress syndrome in the postoperative course, but the remaining five patients were discharged with their wounds well healed. Acute and deep mediastinal infection occurred in one patient on the fifth day after cardiac surgery. The infection was successfully treated with radical debridement, two days of intermittent mediastinal irrigation and staged wound closure with omental transposition into the mediastinum. The omental transfer was achieved as follows: after the greater omentum was divided into two pedicles one pedicle was used to fill in the pericardial space and the other was placed between the sternum and the undermined skin. We conclude that early debridement and omental flap transposition are effective in the management of mediastinitis after cardiac surgery.

Aged↗
PubMed1993

[Influence of thoracotomy and partial lung resection on pulmonary function: comparison with median sternotomy].

The influence of thoracotomy on respiratory function was examined in 49 patients: 22 with intercostal thoracotomy without lung resection (ICT), 11 with partial lung resection (PLR) and 16 with median sternotomy (MST). Respiratory function (FVC, FEV1.0 and FEV1.0%) was measured preoperatively, in the early stage (14 days) and in the stable stage (after 3 months) postoperatively. In each group, the FVC and FEV1.0 were decreased to 70-80% of preoperative respiratory function in the early stage and rose to 90-95% in the stable stage. There were no significant differences among the groups. FEV1.0% did not vary in the different stages in any of the three groups. The ICT group was classified according to the type of skin incision (axillary incision (AI), anterolateral incision (ALI) and posterolateral incision (PLI)). FVC and FEV1.0 in the ALI subgroup were higher (p < 0.05) than in the PLI subgroup in the early stage. These results suggest that the selection of the skin incision is important for preserving respiratory function.

Adult↗
PubMed1994

[Curative report of post sternotomy mediastinitis due to bacterofungal infection].

We describe a 72-year-old patient with mediastinitis caused by Methicillin-resistant Staphylococcus aureus (MRSA) and Candida albicans after median sternotomy who was successfully treated with wound closure with pectoral musculocutaneous flap and closed continuous mediastinal irrigation. The irrigation device consisted of two pairs of irrigation and suction tubes which placed upper and lower half of mediastinum respectively, in which high rate irrigation technique (200 ml/h) was employed using 0.01% of Vancomycin hydrochloride as a base agent and additional 0.1% of Povidone-iodine in early phase and 0.01% of Fluconazole in late phase. After 12-days irrigation, the drainage culture turned negative and the wound was healed and tomographically granulated. High rate irrigation with sufficient concentration of antimicrobial agents selected according to each organism sensitivity could eliminate redundant irrigation and contribute to avoid antimicrobial toxication. We experienced also another four cases (two caused by MRSA, two caused by Serratia liquefaciens) treated successfully with this technique. These results led us to believe that continuous mediastinal irrigation technique could be carried out with safe and effectiveness so far as high rate irrigation with low concentration of Povidone-iodine is employed.

Aged↗
PubMed1993

[Closure of sternotomy with Cotrel staplers].

The authors describe a new method for the closure of median sternotomies based on immediate compression with two or three Cotrel-Dubousset (CD) staples. This method was effective in a series of 100 patients. It was the curative treatment of septic sternal pseudarthrosis, and has been extended to high risk patients (age, severe sternal osteoporosis, obesity, diabetes, chronic respiratory insufficiency) or when surgery requires resection of the internal mammary arteries (IMA).

Aged↗
PubMed1995

[Evaluation of neck lymph node dissection and extended lymphadenectomy through a collar incision and median sternotomy for lung cancer].

Since 1983, 421 patients have been treated for lung cancer at this institute. Since 1988, neck lymph node dissection (11 cases) and new extended lymphadenectomy through a collar incision and median sternotomy (22 cases) have been conducted. Indications for this new radical operation are scalene, supraclavicular or highest mediastinal node involvement, or superior pulmonary sulcus carcinoma, in patients aged 70 or less without distant metastasis and NSCLC. No major complications and operative mortality were encountered in this study. Patients with scalene or supraclavicular node involvement showed poor prognosis. Postsurgical local recurrence was frequent. Whether resection in N3 disease should be conducted or not, remains a point of controversy. The authors consider that lymphadenectomy should be conducted more extensively. A significant better survival of N2 disease and satisfactory prognosis of patients without metastasis of cervical lymph nodes demonstrates the effectiveness of neck lymph node dissection in the present superradical operation for lung cancer.

Adult↗
PubMed1996

The combined cervical and partial sternotomy approach for thymectomy.

Removal of a normal appearing thymus gland may be necessary, particularly in patients with myasthenia gravis. Complete removal is a basic tenet of this type of operation. A combined cervical and upper sternotomy incision is described. This is appropriate for thymectomy in such patients because of the minimal morbidity and excellent exposure for the thoracic portion of the thymus gland.

Cervical Vertebrae↗
PubMed1977

[Technical variants of median sternotomy].

Various modifications of the technique of median sternotomy are described. Advantages thus obtained with respective to saving time and better haemostasis are explained.

Cardiac Surgical Procedures↗
PubMed1996

Sternotomy infections: sternal salvage and the importance of sternal stability.

OBJECTIVE: To review the management of sternal wound infection after cardiovascular surgery. DESIGN: Retrospective case study. SETTING: All management took place in a single tertiary-care university hospital. PATIENTS: Twenty-one consecutive patients seen over a 3-year period who had infected median sternotomy incisions after cardiovascular surgery. INTERVENTIONS: Surgical eradication of infection, including sternal débridement and rewiring or placement of vascularized muscle flaps, or both. MAIN OUTCOME MEASURES: Resolution of infection and restoration of sternal stability. RESULTS: The development of sternal wound infection was found to be associated with sternal instability. In 12 of 17 patients treated initially with sternal débridement and rewiring the infection was cured. Vascularized muscle flap transfers were required to eradicate the infection in the remaining patients. CONCLUSIONS: Sternal débridement and rewiring is an effective initial treatment for sternal wound infections in selected patients. Some patients may require placement of muscle flaps for definitive treatment.

Adult↗
PubMed1996

Sternotomy infection with Mycoplasma hominis: a cause of "culture negative" wound infection.

Wound infections with Mycoplasma species are unusual; diagnosis may be delayed because of the growth characteristics of this organism. We report Mycoplasma hominis infection of sternotomy wounds in two patients. The first presented with fever and drainage from the incision 1 week after coronary artery bypass grafting. The other patient presented with drainage from the incision three weeks after double-lung transplantation. In both cases, initial cultures were negative, but the typical colonial morphology of M. hominis was subsequently detected. Successful treatment consisted of debridement and long courses of antibiotic therapy; omental flap grafting was eventually required for the second patient. Other published cases were reviewed and compared with the newly reported cases.

Aged↗
PubMedDate not supplied

[Submammary skin incision for longitudinal medial sternotomy].

The submammary incision has been postulated as an alternative in median sternotomy approach since 1960. We used this incision in 32 females patients from 1 to 24 years. The diagnoses were atrial septal defects (ASD) 23 patients, ventricular septal defect (VSD) 2 patients, double outlet right ventricle 1 patient, supravalvular aortic stenosis 1 patient, ASD with VSD 3 patients and partial anomalous pulmonary venous connection 1 patient. Nine patients had a complication: cheloid scar 1 patient, seroma 2 patients, wound dehiscence 3 patients, and diminution of sensitivity 3 patients. We conclude, that this type of surgical approach is an excellent alternative for women with good aesthetic and psychological results. Their complications are easy to correct.

Adolescent↗
PubMed1997

[Sasumata(U+I) shape skin incision for the surgery through median sternotomy].

Since April, 1994 we have tried median sternotomy in a new skin incision which resembles to "Sasumata", a Japanese historical weapon of police, for the surgery of eleven patients with thymic disease or lung cancer for cosmetic reasons. An U-shaped skin incision in the upper half portion of the breast and a vertical incision from the bottom of "U" to xyphoid process were made. A comparison was made in eight patients with former conventional method, a linear incision on the sternum. The new incision was useful not only for cosmetic reasons but also for the following reasons; enough operation area, good lymph node dissection from lower neck to upper mediastinum without additional collar incision, and good healing of the skin. There were no differences between the two incision groups on operation time, bleeding volume and hospital stay after surgery. In a postoperative research almost all patients have been satisfied with the new incision.

Adult↗
PubMedDate not supplied

Tumour presenting as a retrosternal abscess following median sternotomy.

A 73-year-old lady, who underwent coronary artery bypass grafting eight months previously, presented with rigors and chest pain. The upper sternum was tender, swollen and erythematous, suggesting a retrosternal abscess. Radiological investigation supported the clinical diagnosis. Local infections following median sternotomy are uncommon, most being early and superficial. Late infections are very uncommon, and should suggest alternative pathology. Following open surgical drainage, histology showed the mass to be a poorly differentiated adenocarcinoma. The primary tumour was never found.

Abscess↗
PubMed1998

False aneurysm of the right internal mammary artery. Late rupture after sternotomy.

This report describes a late, near-fatal rupture of a false aneurysm of the right internal mammary artery subsequent to coronary artery bypass grafting. The patient presented to us in shock due to hemorrhaging, 8 weeks after bypass surgery that had been complicated by sternal fracture, dehiscence, and infection. Emergent thoracotomy and suture ligation controlled the hemorrhage. To the best of our knowledge, this is the 1st reported case of late massive hemorrhage caused by injury to an internal mammary artery after sternotomy. The literature is reviewed and discussed.

Aged↗