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Fracture Nitinol
Fracture Nitinol
Fracture Nitinol
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http://icvts.ctsnetjournals.org/cgi/content/full/10/3/465
Interactive Cardiovascular and Thoracic Surgery is the official journal of the European Association
for Cardio-thoracic Surgery (EACTS) and the European Society for Cardiovascular Surgery
(ESCVS). Copyright © 2010 by European Association for Cardio-thoracic Surgery. Print ISSN:
1569-9293.
doi:10.1510/icvts.2009.218867
Editorial
New Ideas
Interactive CardioVascular and Thoracic Surgery 10 (2010) 465–466
www.icvts.org
Progress Report
Traumatic fracture of nitinol thermoreactive sternal clips
Work in
Jack Broadhurst, Narain Moorjani*, Sunil Ohri
Department of Cardiothoracic Surgery, Southampton General Hospital, Southampton, SO16 6YD, UK
Protocol
Received 11 August 2009; received in revised form 10 November 2009; accepted 17 November 2009
Abstract
Institutional
Report
Median sternotomy can be associated with significant morbidity, including non-union, dehiscence and mediastinitis. The use of flexible
thermoreactive sternal clips has been introduced recently as an alternative method of sternal closure and is advocated in patients at
increased risk of sternal breakdown. It is associated with a decreased incidence of sternal complications as well as allowing faster sternal
closure and easy removal on resternotomy. This report describes the case of a fractured thermoreactive clip following trauma, resulting in
Article
sternal dehiscence necessitating sternal rewiring.
ESCVS
䊚 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.
Negative
dehiscence, mediastinitis, superficial wound infection and
Results
ing the use of the left internal mammary artery. In view of
fistula w1x. Following cardiac surgery, sternal wound com-
his age, comorbidities and markedly osteoporotic sternum
plications occur in ;2–5% of patients w2x. There are mul-
observed intraoperatively, the sternum was closed using
tiple risk factors for these complications including obesity,
nitinol thermoclips. Interrupted stainless steel wires were
Follow-up
diabetes, renal impairment, chronic obstructive pulmonary
Paper
initially placed in the manubrium and a single wire placed
disease, steroids, advanced age, osteoporosis, smoking and
harvesting bilateral internal mammary arteries w3, 4x. Rou- inferiorly just above the level of the xiphoid process to
tine closure of median sternotomy in adults usually involves achieve sternal approximation. Electrocautery was then
State-of-the-art
5–9 interrupted stainless steel wires used to achieve osse- used to create a passage through the 3rd, 4th and 5th
ous apposition of the two hemisternums. The pressure point intercostal spaces immediately adjacent to the sternal
of contact during the closure is determined by the diameter edge, taking care not to injure the remaining right internal
of the wire. If bony apposition is not exact or if there is mammary artery. Backaus forceps were placed into the
excessive movement, such as in patients with lower respi- spaces to determine the size of each clip (ranging between
Best Evidence
ratory tract infections or chronic obstructive pulmonary 20 mm and 40 mm). The clips were placed in ice-cooled
Topic
disease, it is possible for the stainless steel wires to water to achieve temperatures -9 8C until they become
‘cheesewire’ through the bone resulting in sternal dehis- malleable. Following mounting on special insertion forceps,
cence w5, 6x. Sternal closure using thermoclips, however, the clips were placed in the intercostal spaces. Once in
distributes the pressure over a wider area as the clips have situ, the clips then warm up to body temperature becoming Nomenclature
a greater diameter at the point of contact w7x. Furthermore, more rigid and conforming to the curve of the intercostal
their thermoreactive properties allow the clips to be slight- spaces. The patient’s initial postoperative recovery was
ly loose at insertion to allow accurate positioning followed uneventful. On the 7th postoperative day, he sustained a
by auto-tightening induced by body temperature, ensuring fall and landed on the metallic edge of his bed, sustaining
good osseous apposition. This report describes the use of direct trauma to the sternum. Clinical examination and
Historical
thermoreactive clips in a high-risk patient and a complica- chest radiograph (Fig. 1) confirmed sternal disruption with
Pages
pulmonary disease and chronic renal impairment, presented with the middle clip dislodged but the superior clip still in
Brief
References
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on the two hemisternums w7x. As the clips do not fully infections after cardiac surgery. Ann Thorac Surg 2007;83:2246–2247.