Abstract
BackgroundStability is essential for the normal healing of a sternotomy. Mechanical vibration transmittance may provide a new means of early detection of diastasis in the sternotomy and thus enable the prevention of further complications. We sought to confirm that vibration transmittance detects sternal diastasis in human tissue.MethodsTen adult human cadavers (8 males and 2 females) were used for sternal assessments with a device constructed in-house to measure the transmittance of a vibration stimulus across the median sternotomy at the second, third, and fourth costal cartilage. Intact bone was compared to two fixed bone junctions, namely a stable wire fixation and an unstable wire fixation with a 10 mm wide diastasis mimicking a widely rupturing sternotomy. A generalized Linear Mixed Model with the lme function was used to determine the ability of the vibration transmittance device to differentiate mechanical settings in the sternotomy.ResultsThe transmitted vibration power was statistically significantly different between the intact chest and stable sternotomy closure, stable and unstable closure, as well as intact and unstable closure (t-values and p-values respectively: t = 6.87, p < 0.001; t = 7.41, p < 0.001; t = 14.3, p < 0.001). The decrease of vibration transmittance from intact to stable at all tested costal levels was 78%, from stable to unstable 58%, and from intact to unstable 91%. The vibration transmittance power was not statistically significantly different between the three tested costal levels (level 3 vs. level 2; level 4 vs. level 2; level 4 vs. level 3; t-values and p-values respectively t = − 0.36, p = 0.723; t = 0.35, p = 0.728; t = 0.71, p = 0.484).ConclusionsVibration transmittance analysis differentiates the intact sternum, wire fixation with exact apposition, and wire fixation with a gap. The gap detection capability is not dependent on the tested costal level. The method may prove useful in the early detection of sternal instability and warrants further exploration.
Highlights
IntroductionMechanical vibration transmittance may provide a new means of early detection of diastasis in the sternotomy and enable the prevention of further complications
Stability is essential for the normal healing of a sternotomy
We have reported vibration transmittance as a tool to assess and follow postoperative sternal stability [28], and we postulated that non-invasive detection of early sternotomy diastasis could be possible
Summary
Mechanical vibration transmittance may provide a new means of early detection of diastasis in the sternotomy and enable the prevention of further complications. We sought to confirm that vibration transmittance detects sternal diastasis in human tissue. The disruption of sternal steel wire fixation occurs when the separating forces exceed the mechanical holding properties of the closure. Even minor instability may cause subjective symptoms and can progress to complete wound disruption often complicated by deep sternal wound infection. Detection of sternal instability may enable preventative measures such as the use of supportive vests as well as surgical exploration and re-fixation of the wound that may prevent the later more severe complications [6,7,8]. Risk factors for instability include numerous patient factors, as well as operative and postoperative variables [9,10,11,12,13,14,15,16,17,18]
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