Bharadwaj Sandeep N, Raikar Connor H, Dumanian Gregory A, Malaisrie S Christopher
Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Division of Plastic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
JTCVS Tech. 2023 Jun 20;20:130-137. doi: 10.1016/j.xjtc.2023.06.002. eCollection 2023 Aug.
Sternal dehiscence is frequently associated with wire-based closures cutting through fragile bone, allowing sternal motion, separation, and infection. We investigated whether bone cutting could be limited by using a newly available mesh suture with improved force distribution.
Five sternal models were closed using 8 interrupted single sternal wires, double sternal wires, braided poly(ethylene terephthalate) sutures, single-wrapped mesh sutures, or double-wrapped mesh sutures. To simulate chest-wall forces, closed sternal models were pulled apart using 1020 N of axial force applied incrementally. Double sternal wire and double-wrapped mesh suture were further compared by closing 3 new models with each material and subjecting these models to cyclic loading cycles, simulating breathing and coughing. Image analysis of needle hole size measured "bone cutting" by each closure material and sternal distraction as a function of force.
All models exhibited maximal separation at the xiphoid. During axial loading, needle hole size increased 7.2% in the double-wrapped mesh suture model and 9.2% in the double-wire model. Single-wrapped mesh suture, single wires, and braided poly(ethylene terephthalate) extended needle hole size by 6.7%, 47.0%, and 168.3% of original size, respectively. The double-wire model resisted sternal distraction best, separating 0.285 cm at the xiphoid. During cyclic loading, mesh suture exhibited significantly less bone cutting ( = .02) than double wire, with comparable levels of sternal separation ( = .07).
Mesh suture may resist bone cutting seen in sternal wire closure in bone models with comparable distraction to currently used sternal closure methods.
胸骨裂开常与钢丝缝合导致脆弱骨质被切割有关，进而引起胸骨活动、分离及感染。我们研究了使用一种新的具有改善力分布的网状缝线是否可以限制骨质切割。
使用8根间断单胸骨钢丝、双胸骨钢丝、编织聚对苯二甲酸乙二酯缝线、单包网状缝线或双包网状缝线对5个胸骨模型进行闭合。为模拟胸壁受力，对闭合的胸骨模型逐渐施加1020 N的轴向力将其拉开。通过用每种材料闭合3个新模型并使其承受模拟呼吸和咳嗽的循环加载周期，进一步比较双胸骨钢丝和双包网状缝线。通过图像分析针孔大小来测量每种闭合材料造成的“骨质切割”以及胸骨牵张随力的变化情况。
所有模型在剑突处均表现出最大分离。在轴向加载过程中，双包网状缝线模型的针孔大小增加了7.2%，双钢丝模型增加了9.2%。单包网状缝线、单根钢丝和编织聚对苯二甲酸乙二酯分别使针孔大小扩展至原始大小的6.7%、47.0%和168.3%。双钢丝模型对胸骨牵张的抵抗最佳，在剑突处分离0.285 cm。在循环加载过程中，网状缝线造成的骨质切割明显少于双钢丝（P = 0.02），胸骨分离程度相当（P = 0.07）。
在与目前使用的胸骨闭合方法具有相当牵张程度的骨质模型中，网状缝线可能抵抗胸骨钢丝闭合中出现的骨质切割。
