Experience using a flexible reinforced fiber suture for sternal closure in bilateral lung transplantation recipients undergoing bilateral transverse thoracosternotomy.
Ontology highlight
ABSTRACT:
SUBMITTER: Coster JN
PROVIDER: S-EPMC9366607 | biostudies-literature | 2022 Aug
REPOSITORIES: biostudies-literature
Publications
Experience using a flexible reinforced fiber suture for sternal closure in bilateral lung transplantation recipients undergoing bilateral transverse thoracosternotomy.
Coster Jenalee N JN Chan Ernest G EG Furukawa Masashi M Sanchez Pablo G PG
JTCVS techniques 20220519
Similar Datasets
Project description:Background:Deep sternal wound infection (DSWI) is a life-threatening complication after cardiac surgery. The aim of this study was to retrospectively evaluate the outcomes of reconstructing infected poststernotomy wounds with either vacuum-assisted closure (VAC) after previous debridement or bilateral pectoralis major muscle flaps (BPMMFs). Methods:In total, 565 patients with postoperative DSWI were enrolled in this study from January 1, 2014, to June 1, 2018. Of these patients, 247 received BPMMFs. To address the indicated biases, a 1:1 propensity score-matched cohort was created based on age, body mass index, preoperative diabetes mellitus, chronic obstructive pulmonary disease (COPD), internal thoracic artery grafting (ITAG), type of cardiac surgery, time before treatment for DSWI and wound classification. After matching, 132 patients who had similar risk profiles were enrolled in the study population (66 in the VAC group: 66 in the BPMMF group). Results:At 21.9±12.1 (median: 24, IQR: 14-28) months of follow-up, the survival rate was 93.9% in the BPMMF group and 74.4% in the VAC group (P<0.01). Compared with the VAC group, the BPMMF group had a significantly decreased length of hospital stay (P<0.01). At the spirometry assessment, the forced expiratory volume in the 1st second (FEV1), vital capacity (VC), and FEV1/VC ratio showed no significant differences in survival between the VAC group and BPMMF group. Conclusions:In our study, compared with VAC therapy, BPMMFs guaranteed better early- and late-term outcomes, as shown by less length of hospital stay, a higher rate of long-term survival and unimpaired respiratory function.
| S-EPMC7139061 | biostudies-literature
Project description: Not available
| S-EPMC8298878 | biostudies-literature
Project description:PurposeThermoreactive nitinol Flexigrip has been developed to ensure better fixation than conventional wire closure. To verify the advantage of Flexigrip over the conventional wiring, we compared early sternal bone healing on computed tomography (CT).MethodsA prospective cohort study enrolled the first consecutive 80 patients with wiring and the second consecutive 44 patients undergoing Flexigrip sternal closure. The primary endpoint was sternal healing evaluated quantitatively using a 6-point scale and measured gaps/offsets of the sternal halves at 6 levels on CT scans on the 14th postoperative day. Secondary endpoints included pain scores and sternal complications 1 month after surgery.ResultsCompared with the patients of wiring, those who received Flexigrips showed higher 6-point scores at most sternum levels, less frequent gaps (52% vs 70%, p = 0.04), lower offsets (3.3 ± 0.9 mm vs 4.3 ± 0.7 mm, p <0.001) at the manubrium, and less frequent gaps (25% vs 43%, p = 0.04) and offsets (2.3% vs 24%, p = 0.002) at the middle of sternum. The pain scores and sternal complication rates were similar between both groups.ConclusionCT evaluation 2 weeks after surgery revealed that Flexigrip sternal closure showed less gaps and offsets of the sternal halves, suggesting faster sternal bone union when compared to the wiring.
| S-EPMC9763714 | biostudies-literature
Project description:Perventricular device closure of ventricular septal defect through midline sternotomy avoids the cardiopulmonary bypass, however, lacks the cosmetic advantage. Perventricular device closure of ventricular septal defect with transverse split sternotomy was performed to add the cosmetic advantage of mini-invasive technique.Thirty-six pediatric patients with mean age 7.14±3.24 months and weight 5.00±0.88 kg were operated for perventricular device closure of ventricular septal defect through transverse split sternotomy in 4th intercostal space under transesophageal echocardiography guidance. In case of failure or complication, surgical closure of ventricular septal defect was performed through the same incision with cervical cannulation of common carotid artery and internal jugular vein for commencement of cardiopulmonary bypass. All the patients were postoperatively followed, and then discharged from hospital due to their surgical outcome, morbidity and mortality.Procedure was successful in 35 patients. Two patients developed transient heart block. Surgical closure of ventricular septal defect was required in one patient. Mean duration of ventilation was 11.83±3.63 hours. Mean intensive care unit and hospital stay were 1.88±0.74 days and 6.58±1.38 days, respectively. There was no in-hospital mortality. A patient died one day after hospital discharge due to arrhythmia. No patients developed wound related, vascular or neurological complication. In a mean follow-up period of 23.3±18.45 months, all 35 patients were doing well without residual defect with regression of pulmonary artery hypertension as seen on transthoracic echocardiography.Transverse split sternotomy incision is a safe and effective alternative to a median sternotomy for perventricular device closure of ventricular septal defect with combined advantage of better cosmetic outcomes and avoidance of cardiopulmonary bypass.
| S-EPMC5570392 | biostudies-other
Project description:Sternal closure after median sternotomy traditionally uses a stainless steel wire cerclage. Sternal wires are placed through or around the sternum, and the wire ends are twisted together to bring the sternum back together. Complications of this technique include sternal instability, dehiscence, non-union, and increased pain. Compared to traditional wire cerclage, the Figure 8 FlatWire Sternal Closure System has been demonstrated to be stronger and significantly reduce sternal cut-through and postoperative pain. There was no significant difference in hospital length of stay or mean hospitalization cost. Operative time was slightly longer in the FlatWire group, but this difference has been attributed to the learning curve of mastering the FlatWire technique. This article and supplemental video will demonstrate the technique of FlatWire Sternal Closure System. Briefly, the FlatWire is placed around the sternum, and the FlatWire end is fed through the security box. Once all of the wires are placed, the Figure 8 tensioning device is used to tighten each wire through the security box to the appropriate tensile force. Next, the FlatWires are rotated 90 degrees to hold the sternal position temporarily. Once sternal approximation is achieved, each FlatWire is twisted 120 degrees, and any excess length of the FlatWire is clipped.
| S-EPMC10586947 | biostudies-literature
Project description:BackgroundPercutaneous suture-based arterial access site closure (ProGlide) is commonly applied in patients undergoing transfemoral transcatheter aortic valve implantation (TAVI). However, the failure of a suture-based vascular closure device (VCD) may require additional treatment.AimsWe aimed to evaluate the efficacy and safety of bailout access site closure using a large-bore plug-based device (MANTA) in patients with failed suture-based closure during transfemoral TAVI.MethodsPatients undergoing a bailout attempt with the MANTA VCD were identified from a prospectively enrolling, institutional registry. Efficacy was defined as haemostasis at the access site without the need for alternative treatment other than manual compression or endovascular ballooning. Safety was defined as freedom from vascular dissection, stenosis and occlusion requiring intervention.ResultsOf 2,505 patients, 66 underwent a bailout attempt with MANTA as a result of ProGlide failure, which occurred before the large-bore sheath insertion in 16.7% of patients and after the sheath removal in 83.3% of patients. Bailout MANTA was deemed effective in 75.8% of patients (50/66), and the technique was considered safe in 86.4% (57/66) of patients. Failure of bailout MANTA occurred because of its superficial application, resulting in persistent bleeding in 18.2% of patients (12/66), and because of its deep application, resulting in stenosis or occlusion in 6.1% of patients (4/66). Operator experience with the technique (odds ratio [OR] 12.29, 95% confidence interval [CI]: 1.99-75.99; p=0.007) and prior use of three ProGlides (OR 0.02, 95% CI: <0.01-0.39; p=0.010) were the only independent predictors of the efficacy endpoint.ConclusionsBailout MANTA after ProGlide failure was effective and safe, but operator experience seems to be crucial. Further technological refinements to facilitate accurate placement appear necessary.
| S-EPMC10941667 | biostudies-literature
Project description:We report the successful control of bleeding in two patients who underwent post-cardiotomy extracorporeal circulatory support (ECMO) and then developed life-threatening bleeding due to severe coagulopathy. After the failure of conventional techniques, bleeding control was achieved using Celox Gauze (MedTrade Products Ltd, Cheshire, UK) packed on the sternal edges and pericardial cavity.
| S-EPMC3352708 | biostudies-literature
Project description:In recent years, flexible silica aerogels have gained significant attention, owing to their excellent thermal and acoustic insulation properties accompanied by mechanical flexibility. Fiber reinforcement of such aerogels results in a further enhancement of the strength and durability of the composite, while retaining the excellent insulation properties. In this paper, the influence of four different kinds of fibers within a flexible silica aerogel matrix is studied and reported. First, a description of the synthesis procedure and the resulting morphology of the four aerogel composites is presented. Their mechanical behavior under uniaxial quasi-static tension and compression is investigated, particularly their performance under uniaxial compression at different temperature conditions (50 °C, 0 °C, and -50 °C). The reinforcement of the flexible silica aerogels with four different fiber types only marginally influences the thermal conductivity but strongly enhances their mechanical properties.
| S-EPMC6766033 | biostudies-literature
Project description:A radial tear of the meniscus can lead to significant loss of meniscus function, resulting in deleterious cartilage changes. Repair of radial meniscus tears has several challenges, including suture pull-out, which can reduce healing success. We present an arthroscopic repair technique in a complete radial lateral meniscus tear using vertical reinforced bars (rebar) of suture tapes to reduce suture pull-out and approximate the radial tear.
| S-EPMC8185810 | biostudies-literature
Project description:In this study, an experimental investigation was conducted on the mechanical properties of lightweight aggregate concrete (LWAC) with different chopped fibers, including basalt fiber (BF) and polyacrylonitrile fiber (PANF). The LWAC performance was studied in regard to compressive strength, splitting tensile strength and shear strength at age of 28 days. In addition, the oven-dried density and water absorption were measured as well to confirm whether the specimens match the requirement of standard. In total, seven different mixture groups were designed and approximately 104 LWAC samples were tested. The test results showed that the oven-dried densities of the LWAC mixtures were in range of 1.819-1.844 t/m3 which satisfied the definition of LWAC by Chinese Standard. Additionally, water absorption decreased with the increasing of fiber content. The development tendency of the specific strength of LWAC was the same as that of the cube compressive strength. The addition of fibers had a significant effect on reducing water absorption. Adding BF and PANF into concrete had a relatively slight impact on the compressive strength but had an obvious effect on splitting tensile strength, flexural strength and shear strength enhancement, respectively. In that regard, a 1.5% fiber volume fraction of BF and PANF showed the maximum increase in strength. The use of BF and PANF could change the failure morphologies of splitting tensile and flexural destruction but almost had slight impact on the shear failure morphology. The strength enhancement parameter ? was proposed to quantify the improvement effect of fibers on cube compressive strength, splitting tensile strength, flexural strength and shear strength, respectively. And the calculation results showed good agreement with test value.
| S-EPMC7178649 | biostudies-literature