Sternotomy Wires Research Articles

Bioengineering Approaches and Novel Biomaterials to Enhance Sternal Wound Healing after Cardiac Surgery: A Crosstalk between Innovation and Surgical Practice.

Median sternotomy and steel wires for sternal closure are the standard approach for cardiac surgery. An incomplete repair associated with chest wall motion, especially in the presence of predisposing factors, can lead to life-threatening deep sternal wound infection, also known as mediastinitis, in 2-5% of cases. Despite current antibiotic and surgical treatments, mediastinitis is associated with a 10-40% mortality rate and a significant increase in morbidity and hospital stay. High mortality and difficult treatment appear to be due to bacterial biofilm, a self-produced extracellular polymeric product that incorporates host tissue and is responsible for the failure of immune defenses and standard antimicrobial therapies. Nanostructures are an effective strategy to enhance the healing process, as they establish a favorable environment for the neosynthesis of the extracellular matrix, supporting tissue development. Synthetic polymers have been proven to exhibit suitable biodegradable and mechanical properties, and their biofunctionalization to enhance cell attachment and interaction with the extracellular matrix is being widely investigated. The use of antibiotic treatments suspended in poly-D,L-lactide and polyethylene oxide and electrospun into nanofibers, or in sponges, has been shown to inhibit bacterial biofilm production. Additionally, growth factors can be incorporated into 3D bioresorbable scaffolds with the aim of constituting a structural and biological framework to organize and expedite the healing process. Therefore, these combined approaches may change the treatment of mediastinitis in the near future.

Effects of coronary artery calcified plaque and stent on severity and survival of COVID-19 patients: a decision tree model study.

We aimed to investigate the relationship between the presence of calcified plaques and stents in coronary arteries as evaluated by the chest computed tomography severity score (CT-SS) and mortality rates in patients with COVID-19. A single-center retrospective analysis was conducted of 492 patients (≥18 yrs) who were hospitalized between March and June 2020. All included patients had RT-PCR tests positive for COVID-19. A radiologist recorded pulmonary imaging findings and the presence of coronary calcified plaque and / or stent, sternotomy wires, and cardiac valve replacement on initial non-contrast chest CT. Also, cardiothoracic ratios (CTR) were calculated on chest CTs. Data were analyzed using univariate and multivariate analyses and a chi-squared automatic interaction detection (CHAID) tree analysis, which was developed as a predictive model for survival of COVID-19 patients according to chest CT findings. The mean CT-SS value of the patients with coronary plaque was 11.88±7.88, and a significant relationship was found between CT-SS with coronary calcified plaque (p<0.001). No statistical difference was found between CT-SS and coronary stent (p=0.296). In multivariate analysis, older age was associated with 1.69‑fold (p< 0.001), the presence of coronary calcified plaque 1.943‑fold (p=0.034) and higher CT-SS 1.038‑fold (p=0.042) higher risk of mortality. In the CHAID tree analysis, the highest mortality rate was seen in patients with coronary plaque and CTR>0.57. The presence of coronary artery calcified plaque and cardiomegaly were high risks for severe prognosis and mortality in COVID-19 patients and may help to predict the survival of patients.

Measurement Data-Based Study on the Intrabody Propagation in the Presence of the Sternotomy Wires and Aortic Valve Implant

This paper presents a comprehensive study on the impact of sternotomy wires and a medical implant on the ultra-wideband (UWB) channel characteristics by studying intrabody propagation in the vicinity of on-body antennas. The main contribution on this paper is to verify propagation path calculations with measurement data taken from a volunteer that has sternotomy wires and an aortic valve implant and from a reference volunteer without any implants. Furthermore, the impact of sternotomy wires and the aortic valve implant is confirmed by finite integration technique (FIT) simulations using a tissue layer model. It is shown that additional signal peaks and variations of the channel impulse responses (CIRs) are observed for the medical implant case since both sternotomy wires and aortic valve implant contain highly conductive materials which affect the channel characteristics. In the time domain simulation results, the difference between the channel strength of the implanted and nonimplanted cases varies between 5 and 17 dB within the time range corresponding to the relevant propagation paths. This phenomenon should be taken into account when designing on-body monitoring devices and when choosing sensor node locations to avoid interference due to the additional multipath propagated signal components. On the other hand, knowledge of the impact of the aortic valve implant may be utilized in the design of devices that can monitor the functionality of a valve implant during the heartbeat.

Comprehensive Study on the Impact of Sternotomy Wires on UWB WBAN Channel Characteristics on the Human Chest Area

This paper presents a comprehensive study on the impact of the sternotomy wires on the characteristics of ultra wideband (UWB) radio propagation channel in the human chest area. The study is conducted using two simulation models: a planar layer model and a three-dimensional elliptical layer model. The study includes antennas designed for on-body and in-body communications. Furthermore, the measured data and propagation path calculations are presented to verify the simulation results. The main purpose is to show how the steel wires affect the on-body channel characteristics and in-body propagation within the tissues when the monitoring antennas are located in close vicinity of the human body. The study is conducted by evaluating: 1) channel characteristics in both frequency and time domains; 2) 2D power flow figures; and 3) Poynting vector values. Furthermore, the impact of the fat layer thickness on the visibility of sternotomy wires is studied. Moreover, the impact of sternotomy wires is studied for the case of the recently operated patient, for which the sternotomy wires are on the sternum bone surface, as well as for the case where the sternotomy wires are embedded into the sternum bone. It is found that sternotomy wires have a clear impact on the channel. The strength of the impact depends on the antenna types used by the monitoring devices, the thickness of the fat layer in the sternum area, and whether the sternotomy wires are on the sternum surface or whether they have already been embedded on the sternum as it happens with time.

The Bionic Man: Surgical and Percutaneous Advances in Heart Failure and D-transposition of the Great Arteries

BackgroundModern advances in surgery and percutaneous interventions have resulted in new therapeutic possibilities for end-stage heart failure in congenital heart disease. We present a case of a patient with D-transposition of the great arteries undergoing multiple surgeries and percutaneous interventions for advanced heart failure.DescriptionA 44-year-old man with D-transposition of the great arteries underwent a Blalock-Hanlon septectomy at age 9 days and a Mustard atrial switch procedure at age 3 years. He received an epicardial ventricular pacemaker at age 12 years for high grade atrioventricular (AV) block. He developed supraventricular tachycardia ten years ago, received electrophysiology ablation, and was found to have an inferior vena cava (IVC) baffle leak for which he underwent Amplatzer occluder device placement. Four years ago, he developed superior vena cava (SVC) and IVC baffle stenosis and underwent dilation and covered stent placements in the SVC and IVC baffles. His pacemaker was upgraded to a biventricular implantable cardioverter defibrillator (ICD) utilizing the epicardial ventricular lead and an endocardial lead through the covered stent in the SVC baffle for primary prevention of sudden cardiac death. Due to worsening heart failure despite inotropic support, the patient underwent systemic HeartWare ventricular assist device (VAD) implantation as a bridge to transplantation.DiscussionThe chest X-ray shows a HeartWare ventricular assist device attached to the systemic right ventricle. The biventricular ICD includes endocardial right-atrial lead, ICD lead in the non-systemic left-ventricle, and two epicardial ventricular leads. Multiple sternotomy wires, endotracheal tube and right internal jugular catheter are seen. The stented superior and inferior vena cava baffles and Amplatzer closure device for baffle leak project over the mediastinum.ConclusionSignificant advances in surgery and percutaneous interventions allow for complex therapeutic options for patients with congenital heart disease and advanced heart failure. Modern advances in surgery and percutaneous interventions have resulted in new therapeutic possibilities for end-stage heart failure in congenital heart disease. We present a case of a patient with D-transposition of the great arteries undergoing multiple surgeries and percutaneous interventions for advanced heart failure. A 44-year-old man with D-transposition of the great arteries underwent a Blalock-Hanlon septectomy at age 9 days and a Mustard atrial switch procedure at age 3 years. He received an epicardial ventricular pacemaker at age 12 years for high grade atrioventricular (AV) block. He developed supraventricular tachycardia ten years ago, received electrophysiology ablation, and was found to have an inferior vena cava (IVC) baffle leak for which he underwent Amplatzer occluder device placement. Four years ago, he developed superior vena cava (SVC) and IVC baffle stenosis and underwent dilation and covered stent placements in the SVC and IVC baffles. His pacemaker was upgraded to a biventricular implantable cardioverter defibrillator (ICD) utilizing the epicardial ventricular lead and an endocardial lead through the covered stent in the SVC baffle for primary prevention of sudden cardiac death. Due to worsening heart failure despite inotropic support, the patient underwent systemic HeartWare ventricular assist device (VAD) implantation as a bridge to transplantation. The chest X-ray shows a HeartWare ventricular assist device attached to the systemic right ventricle. The biventricular ICD includes endocardial right-atrial lead, ICD lead in the non-systemic left-ventricle, and two epicardial ventricular leads. Multiple sternotomy wires, endotracheal tube and right internal jugular catheter are seen. The stented superior and inferior vena cava baffles and Amplatzer closure device for baffle leak project over the mediastinum. Significant advances in surgery and percutaneous interventions allow for complex therapeutic options for patients with congenital heart disease and advanced heart failure.

Radiographic identification using midline medical sternotomy wires.

Forensic anthropologists are regularly asked to assist with the identification of unknown individuals using comparative medical radiography. This study addressed the use of midline medical sternotomy wires as a means for personal identification. Antemortem and postmortem radiographic comparisons were completed by 46 professional forensic anthropologists and anthropology graduate students familiar with comparative medical radiography as a technique for assessing identification. Participants were asked to make five radiographic matches from a pool of 20 radiographs. Participants also completed an anonymous survey detailing their education level and experience making radiographic comparisons. Participants were 99.5% accurate in matching the radiographs. Sensitivity was 98.7%, and specificity was 99.7%. Logistic regression analysis found no statistically significant differences in the participants' ability to make a correct match. As the high accuracy rates indicate, the shape, size, and various characteristics of the sternotomy wires are individualizing and can confidently be used when assisting with personal identification cases.

Unexpected Cause for Chest Pain

A 71-year-old man was admitted to our hospital with new onset of typical symptoms of angina on exertion corresponding to a Canadian Cardiovascular Society functional class III. The patient had undergone mitral valve replacement with a mechanical bileaflet valve (ATS medical prosthesis, ATS Medical Inc., Minneapolis, Minn.) in December 1997 and transvenous pacemaker implantation for intermittent high-degree atrioventricular node block (Biotronik Philos II DR, ventricular demand inhibited pacemaker mode VVIR0, Biotronik SE & Co. KG, Berlin, Germany) in 2006. Medical history revealed chronic kidney disease and diabetes mellitus. He had chronic atrial fibrillation and was taking oral anticoagulants. The ECG showed discrete ST depression in leads I, II, III, and aVF (Figure 1). Cardiac troponin T on admission was slightly elevated (0.046 ng/mL; reference value at our institution is <0.0014 ng/mL), and his creatine kinase-MB was negative. Anterior-posterior and lateral chest x-ray showed a fracture of the sixth sternal wire with the lateral view showing a protrusion of the cerclage loop into the anterior mediastinum (Figure 2). Transthoracic echocardiography revealed moderately …

Variations in normal sternoclavicular joints; a retrospective study to quantify SCJ asymmetry

A wide degree of normal anatomical variation can occur at the sternoclavicular joint (SCJ). On occasion, this has led to concern for a pathological process, potentially resulting in a costly work-up, unnecessary patient worry and invasive diagnostic procedures such as biopsy. The purpose of this study was to determine the normal range of anatomical variation at sternoclavicular joints. One hundred four consecutive patients with chest CT done at our institution were selected. Patients with clear SCJ pathology, chest wall abnormality, CT slice thickness greater than 5 mm and sternotomy wires, were excluded. Chart review was done and showed no SCJ symptoms/signs. We measured the SCJ space, maximum clavicular head diameter within the joint and the distance from manubrium to the anterior margin of the clavicular head. Left and right SCJ space ranged from 0.2 to 1.37 cm. The difference (delta or asymmetry) between left SCJ space and right SCJ space ranged from 0 (symmetrical) to 0.57 cm in 104 cases. Left and right clavicular head diameter ranged from 1.2 to 3.7 cm with left/right asymmetry (delta) ranging from 0 (symmetrical) to 1 cm. Manubrium to anterior margin of clavicular head ranged from 0.1 to 2.13 cm with delta ranging from 0 to 0.8 cm. Thirty-three patients demonstrated gas in the joint, five had poor articulation and four had calcification in the joint. Greater than 10% of patients show substantial asymmetry in the sternoclavicular joints, which may be misinterpreted as pathological. Gas in the joint is a common phenomenon therefore should not be an indication for further work-up in asymptomatic patients and likely excludes the presence of effusion.

Vein graft pseudoaneurysm

An 81-year-old man underwent a routine chest x -ray examination (fig 1) before cystoscopy performed to investigate painless haematuria; he was otherwise well. This showed a 10 cm lobulated mass...

Pyogenic Granuloma Caused by Exposed Sternotomy Wires

This case describes a 75-year-old African American man who developed a pyogenic granuloma on the chest due to trauma induced by exposed sternotomy wires from his coronary bypass procedure. To describe a previously unreported cause of pyogenic granuloma. The pyogenic granuloma was excised and during the procedure, exposed sternotomy wires were uncoiled at the base of the lesion. The sternotomy wires were retightened and reappositioned along the sternum, and the wound was closed primarily. The pyogenic granuloma has not recurred after 15 months of follow-up. Pyogenic granulomas are vascular benign tumors that commonly appear secondary to trauma. The source of the trauma in this case was the exposed sternotomy wires.

Pyogenic Granuloma Caused by Exposed Sternotomy Wires

Pyogenic Granuloma Caused by Exposed Sternotomy Wires

Puncture wound during CPR from sternotomy wires: Case report and discussion of periresuscitation infection risks

Performing resuscitations presents multiple infectious risks to critical care providers. Potential sources for infection include direct contact with blood and other bodily fluids and possible inoculation through needlestick injuries. In this article, we present a case of a cardiac care unit nurse who, while providing cardiopulmonary resuscitation, suffered a puncture wound to her left hand from the patient’s sternotomy wires from previous cardiac surgery. The patient died despite these resuscitation efforts. He was seronegative for human immunodefiency virus, hepatitis B, and hepatitis C, and the nurse’s wound healed without complications. This is the first reported case of such an injury occurring during a resuscitation. It demonstrates how a subtle, invisible, and unrecognized physical risk could cause infection in critical care providers. (Heart Lung® 2001;30:159-60.)

Sensitivity to sternotomy wires may cause postoperative pruritus

An eczematous eruption developed on the anterior chest of a 58-year-old woman with known nickel sensitivity after the insertion of nickel-containing sternotomy wires. Her wound was revised with removal of the wires to give immediate and sustained relief from the itch. The electron microscopy and parasternal biopsy histology demonstrating a sarcoidal reaction are discussed.