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PubMed1989

Repair of the dehisced median sternotomy incision.

Mediastinitis after open-heart surgery is a potentially disabling, even lethal, condition. The utilization of muscle flaps in treatment has lowered the mortality rate from 40 to 5 per cent and decreased the hospitalization time to 12 days. The authors recommend a single reverse turnover pectoralis major flap based on the internal mammary perforators as the procedure of choice in these cases.

Humans↗
PubMed1997

Coronary artery bypass grafting without cardiopulmonary bypass through sternotomy and minimally invasive procedure.

Coronary artery bypass grafting without cardiopulmonary bypass (CPB) is now an accepted technique of myocardial revascularization in a special subset of patients. This paper presents our total experience in 1761 cases operated on since September 1981 until April 1997 out of a total of 9164 patients revascularized with the conventional technique during this period of time. Among the 1761 patients, 53 (3%) were operated on by minimally invasive surgery. The overall applicability was 19.2% and the most common grafted arteries were left anterior descending artery (LAD), right coronary artery (RCA), and diagonal. Results indicate that the operation can be performed with an acceptable mortality (2.3%) and that all types of arterial conduits can be used. The incidence of major postoperative complications were significantly lower in this group of patients when compared with our patients receiving conventional myocardial revascularization. Most importantly there was decrease cost when the procedure was used because no extracorporeal circulation cardioplegia sets or other cannulas were used. We conclude based on in this fifteen years experience that the technique of myocardial revascularization in a beating heart is justified, safe and can offer to selected patients the best option of coronary insufficiency surgical treatment.

Adult↗
PubMed1998

Radical debridement and omental transposition for post sternotomy mediastinitis.

OBJECTIVE: Reported mortality for postoperative mediastinitis treated by debridement alone can reach 40%. The authors' experience with radical debridement and omental transposition is reviewed. METHODS: Between May 1990 and August 1996, 14 patients with untractable mediastinitis had a transfer of the greater omentum: 11 after coronary artery bypass grafting (CABG) (6 bilateral internal thoracic arteries ITA grafts), one after a heart transplant, one after an aortic valve replacement and CABG, and one after a repair of the aortic isthmus related to a motor vehicle accident. The mean age was 63 +/- 8 years. Infection was proven in all patients by cultures of intraoperative specimens. Two patients had such a large sternal defect that no primary closure could be attempted. The remaining 12 patients had a mean of 1.4 +/- 0.7 previous debridement. Five patients had a total sternectomy. After radical debridement, the omentum was transferred over the entirety of the wound and covered with a meshed thin skin graft. All patients had a minimum of 4 weeks of i.v. antibiotic therapy. RESULTS: There was no operative death. Apart from one focal necrosis and one traumatic dehiscence of the omentum, there was no hospital complication. Sepsis was controlled in all patients. The median hospital stay was 31 days (range 20-154 days). At a median follow-up of 20 months (range: 6-44 months), there were two late deaths: one sudden and unexpected death and one after a re-do CABG. The remaining patients had resumed their previous activities. One patient had developed an incisional hernia and another underwent further surgery for cosmetic reasons. CONCLUSION: Radical debridement and omental transposition may achieve a cure for postoperative mediastinitis with good mid-term results.

Aged↗
PubMed1997

Easy closure of sternotomy by the Erk needleholder.

Conventional needleholders have elastic arms and lock with the aid of three or four triangle-shaped teeth ends on the arms. Because of these springs, the needle is not absolutely fixed. The Erk needleholder has thick, rigid and strong arms. Locking is obtained by the counter-balancing system and it securely holds the needle.

Equipment Design↗