Dogan OF, Demircin M, Duman U, Ozsoy F, Acaroglu E.

Department of Cardiovascular Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey. ofdogan@hacettepe.edu.tr

OBJECTIVES: Various comparative studies and techniques have been described for median sternotomy closure in the literature, previously. However, some patients are still under risk of sternal dehiscence, malunion or nonunion due to intrinsic or extrinsic factors after median sternotomy closure. Sternal nonunion described as sternal pain, with clicking, instability, or both for more than 3 months in the absence of infection, is an uncommon complication of midline sternotomy incision. To date, only a few studies have addressed the entity of sternal nonunion and its treatment. MATERIAL AND METHOD: The suture anchor system has been described for the fixation of tendons or ligaments to the bone in the orthopedic, and then in cardiac surgery for closure of sternum. In the present study, we used different methods for correction and reduction of sternal nonunion with the use of suture anchors and it accompanied steel wires as an alternative technique in a male patient after coronary artery bypass grafting. RESULTS: There was no complication due to suture anchors. Sternal stability, reduction, and fixation were achieved successfully. CONCLUSION: Sternal nonunion and dehiscence may be the cause of prolonged hospitalization and increased mortality and morbidity if the patient is not treated surgically. This device may protect the wire from cutting into the sternal bone because the thoracal lateral enforcement may be decreased by the devices when the patient is breathing, and with upper extremity movement. This technique can be used easily, safely, and effectively in the repair of sternal nonunion.
OBJECTIVES: Various comparative studies and techniques have been described for median sternotomy closure in the literature, previously. However, some patients are still under risk of sternal dehiscence, malunion or nonunion due to intrinsic or extrinsic factors after median sternotomy closure. Sternal nonunion described as sternal pain, with clicking, instability, or both for more than 3 months in the absence of infection, is an uncommon complication of midline sternotomy incision. To date, only a few studies have addressed the entity of sternal nonunion and its treatment. MATERIAL AND METHOD: The suture anchor system has been described for the fixation of tendons or ligaments to the bone in the orthopedic, and then in cardiac surgery for closure of sternum. In the present study, we used different methods for correction and reduction of sternal nonunion with the use of suture anchors and it accompanied steel wires as an alternative technique in a male patient after coronary artery bypass grafting. RESULTS: There was no complication due to suture anchors. Sternal stability, reduction, and fixation were achieved successfully. CONCLUSION: Sternal nonunion and dehiscence may be the cause of prolonged hospitalization and increased mortality and morbidity if the patient is not treated surgically. This device may protect the wire from cutting into the sternal bone because the thoracal lateral enforcement may be decreased by the devices when the patient is breathing, and with upper extremity movement. This technique can be used easily, safely, and effectively in the repair of sternal nonunion.

Heart Surg Forum. 2005;8(5):E364-9.