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Figure-of-Eight Wire Sternal Closure Technique Can Reduce Post-Open Cardiovascular Surgery Chest Re-Exploration and Pain Scores in Diabetic Patients with Severe Obesity (Body Mass Index: 35-40)

Received: 8 June 2015     Accepted: 10 August 2015     Published: 11 August 2015
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Abstract

Background. Postoperative sternal instability can be associated with the density of bone and type of wire closure. Sternal instability is a serious complication, especially in diabetic obese patients. This category of patients is susceptible to activation of inflammation and inflammatory and/or infective involvement of the sternum after sternotomy. This study was designed to evaluate the comparison of safety and efficacy of figure-of-eight with simple wire sternal closure technique in high-risk diabetic severe obese patients [Body mass index (BMI): 35-40]. Methods and materials. This study, conducted on 80 diabetic patients with severe obesity (BMI: 35-40) undergoing elective off-pump coronary artery bypass graft (CABG) surgery in duration from the first day to two weeks after surgery. Sternal wire closure techniques are divided into two groups, group A (n=40), patients undergoing simple wire closure and group B (n=40), patients undergoing figure-of-eight wire closure. Results. The average age of patients was 64.7±13.2 years. According to the patient self-rated numeric pain intensity scale, the pain of sternum related to existing of wire closure was classified to mild [(group A: n=14), (group B: n=17)], moderate [(group A: n=14), (group B: 19)], and severe [(group A: n=12), (group B: 4)]. Postoperative pain scores had significant higher difference in simple closure than figure-of-eight technique. From all patients, three cases with figure-of-eight and seven cases with simple wire closure had chest re-exploration after surgery. Chest re-exploration in group of figure-of-eight was lower than group of simple closure significantly (p=0.03). Postoperative utilization of inotropic agents, mediastinitis, cerebrovascular accident (CVA) and atrial fibrillation (AF) had not significant differences between both techniques. Conclusion. These findings show that figure-of-eight sternal wire closure technique can reduce postoperative pain scores and chest re-exploration significantly in diabetic patients with severe obesity.

Published in International Journal of Clinical and Experimental Medical Sciences (Volume 1, Issue 3)
DOI 10.11648/j.ijcems.20150103.12
Page(s) 38-41
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2015. Published by Science Publishing Group

Keywords

Figure-of-Eight Wire Sternal Closure, Obesity, Diabetic Patients, Off Pump CABG

References
[1] Sá MP, Ferraz PE, Escobar RR, et al. Off-pump versus on-pump coronary artery bypass surgery: meta-analysis and meta-regression of 13,524 patients from randomized trials. Rev Bras Cir Cardiovasc. 2012; 27:631-641.
[2] Tekümit H, Cenal AR, Tataroğlu C, Uzun K, Akinci E. Comparison of figure-of-eight and simple wire sternal closure techniques in patients with non-microbial sternal dehiscence. Anadolu Kardiyol Derg. 2009;9:411-416.
[3] Molina JE, Lew RS, Hyland KJ. Postoperative sternal dehiscence in obese patients: incidence and prevention. Ann Thorac Surg. 2004;78:912-917.
[4] Kamiya H, Al-maisary SS, Akhyari P, et al. The number of wires for sternal closure has a significant influence on sternal complications in high-risk patients. Interact Cardiovasc Thorac Surg. 2012;15:665-670.
[5] Cullen A, Ferguson A. Perioperative management of the severely obese patient: a selective pathophysiological review. Can J Anaesth. 2012;59:974-996.
[6] Shaikhrezai K, Robertson FL, Anderson SE, Slight RD, Brackenbury ET. Does the number of wires used to close a sternotomy have an impact on deep sternal wound infection? Interact Cardiovasc Thorac Surg. 2012;15:219-222.
[7] Olbrecht VA, Barreiro CJ, Bonde PN, et al. Clinical outcomes of noninfectious sternal dehiscence after median sternotomy. Ann Thorac Surg. 2006;82:902-907.
[8] Raman J, Lehmann S, Zehr K, et al. Sternal closure with rigid plate fixation versus wire closure: a randomized controlled multicenter trial. Ann Thorac Surg. 2012;94:1854-1861.
[9] Aykut K, Celik B, Acıkel U. Figure-of-eight versus prophylactic sternal weave closure of median sternotomy in diabetic obese patients undergoing coronary artery bypass grafting. Ann Thorac Surg. 2011;92:638-641.
[10] Ramzisham AR, Raflis AR, Khairulasri MG, Ooi Su Min J, Fikri AM, Zamrin MD. Figure-of-eight vs. interrupted sternal wire closure of median sternotomy. Asian Cardiovasc Thorac Ann. 2009;17:587-591.
[11] Vural AH, Yalçinkaya S, Türk T, et al. Sternal closure reinforced with rib heads: a novel technique for prevention and treatment of sternal dehiscence. Heart Surg Forum. 2007;10:E397-400.
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    Seyed Jalil Mirhosseini, Sadegh Ali-Hassan-Sayegh, Seyed Mohammad Yousof Mostafavi-Pour-Manshadi, Nafiseh Naderi, Maryam Hadibarhaghtalab, et al. (2015). Figure-of-Eight Wire Sternal Closure Technique Can Reduce Post-Open Cardiovascular Surgery Chest Re-Exploration and Pain Scores in Diabetic Patients with Severe Obesity (Body Mass Index: 35-40). International Journal of Clinical and Experimental Medical Sciences, 1(3), 38-41. https://doi.org/10.11648/j.ijcems.20150103.12

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    Seyed Jalil Mirhosseini; Sadegh Ali-Hassan-Sayegh; Seyed Mohammad Yousof Mostafavi-Pour-Manshadi; Nafiseh Naderi; Maryam Hadibarhaghtalab, et al. Figure-of-Eight Wire Sternal Closure Technique Can Reduce Post-Open Cardiovascular Surgery Chest Re-Exploration and Pain Scores in Diabetic Patients with Severe Obesity (Body Mass Index: 35-40). Int. J. Clin. Exp. Med. Sci. 2015, 1(3), 38-41. doi: 10.11648/j.ijcems.20150103.12

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    AMA Style

    Seyed Jalil Mirhosseini, Sadegh Ali-Hassan-Sayegh, Seyed Mohammad Yousof Mostafavi-Pour-Manshadi, Nafiseh Naderi, Maryam Hadibarhaghtalab, et al. Figure-of-Eight Wire Sternal Closure Technique Can Reduce Post-Open Cardiovascular Surgery Chest Re-Exploration and Pain Scores in Diabetic Patients with Severe Obesity (Body Mass Index: 35-40). Int J Clin Exp Med Sci. 2015;1(3):38-41. doi: 10.11648/j.ijcems.20150103.12

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  • @article{10.11648/j.ijcems.20150103.12,
      author = {Seyed Jalil Mirhosseini and Sadegh Ali-Hassan-Sayegh and Seyed Mohammad Yousof Mostafavi-Pour-Manshadi and Nafiseh Naderi and Maryam Hadibarhaghtalab and Mohammad Reza Lotfaliani},
      title = {Figure-of-Eight Wire Sternal Closure Technique Can Reduce Post-Open Cardiovascular Surgery Chest Re-Exploration and Pain Scores in Diabetic Patients with Severe Obesity (Body Mass Index: 35-40)},
      journal = {International Journal of Clinical and Experimental Medical Sciences},
      volume = {1},
      number = {3},
      pages = {38-41},
      doi = {10.11648/j.ijcems.20150103.12},
      url = {https://doi.org/10.11648/j.ijcems.20150103.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20150103.12},
      abstract = {Background. Postoperative sternal instability can be associated with the density of bone and type of wire closure. Sternal instability is a serious complication, especially in diabetic obese patients. This category of patients is susceptible to activation of inflammation and inflammatory and/or infective involvement of the sternum after sternotomy. This study was designed to evaluate the comparison of safety and efficacy of figure-of-eight with simple wire sternal closure technique in high-risk diabetic severe obese patients [Body mass index (BMI): 35-40]. Methods and materials. This study, conducted on 80 diabetic patients with severe obesity (BMI: 35-40) undergoing elective off-pump coronary artery bypass graft (CABG) surgery in duration from the first day to two weeks after surgery. Sternal wire closure techniques are divided into two groups, group A (n=40), patients undergoing simple wire closure and group B (n=40), patients undergoing figure-of-eight wire closure. Results. The average age of patients was 64.7±13.2 years. According to the patient self-rated numeric pain intensity scale, the pain of sternum related to existing of wire closure was classified to mild [(group A: n=14), (group B: n=17)], moderate [(group A: n=14), (group B: 19)], and severe [(group A: n=12), (group B: 4)]. Postoperative pain scores had significant higher difference in simple closure than figure-of-eight technique. From all patients, three cases with figure-of-eight and seven cases with simple wire closure had chest re-exploration after surgery. Chest re-exploration in group of figure-of-eight was lower than group of simple closure significantly (p=0.03). Postoperative utilization of inotropic agents, mediastinitis, cerebrovascular accident (CVA) and atrial fibrillation (AF) had not significant differences between both techniques. Conclusion. These findings show that figure-of-eight sternal wire closure technique can reduce postoperative pain scores and chest re-exploration significantly in diabetic patients with severe obesity.},
     year = {2015}
    }
    

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  • TY  - JOUR
    T1  - Figure-of-Eight Wire Sternal Closure Technique Can Reduce Post-Open Cardiovascular Surgery Chest Re-Exploration and Pain Scores in Diabetic Patients with Severe Obesity (Body Mass Index: 35-40)
    AU  - Seyed Jalil Mirhosseini
    AU  - Sadegh Ali-Hassan-Sayegh
    AU  - Seyed Mohammad Yousof Mostafavi-Pour-Manshadi
    AU  - Nafiseh Naderi
    AU  - Maryam Hadibarhaghtalab
    AU  - Mohammad Reza Lotfaliani
    Y1  - 2015/08/11
    PY  - 2015
    N1  - https://doi.org/10.11648/j.ijcems.20150103.12
    DO  - 10.11648/j.ijcems.20150103.12
    T2  - International Journal of Clinical and Experimental Medical Sciences
    JF  - International Journal of Clinical and Experimental Medical Sciences
    JO  - International Journal of Clinical and Experimental Medical Sciences
    SP  - 38
    EP  - 41
    PB  - Science Publishing Group
    SN  - 2469-8032
    UR  - https://doi.org/10.11648/j.ijcems.20150103.12
    AB  - Background. Postoperative sternal instability can be associated with the density of bone and type of wire closure. Sternal instability is a serious complication, especially in diabetic obese patients. This category of patients is susceptible to activation of inflammation and inflammatory and/or infective involvement of the sternum after sternotomy. This study was designed to evaluate the comparison of safety and efficacy of figure-of-eight with simple wire sternal closure technique in high-risk diabetic severe obese patients [Body mass index (BMI): 35-40]. Methods and materials. This study, conducted on 80 diabetic patients with severe obesity (BMI: 35-40) undergoing elective off-pump coronary artery bypass graft (CABG) surgery in duration from the first day to two weeks after surgery. Sternal wire closure techniques are divided into two groups, group A (n=40), patients undergoing simple wire closure and group B (n=40), patients undergoing figure-of-eight wire closure. Results. The average age of patients was 64.7±13.2 years. According to the patient self-rated numeric pain intensity scale, the pain of sternum related to existing of wire closure was classified to mild [(group A: n=14), (group B: n=17)], moderate [(group A: n=14), (group B: 19)], and severe [(group A: n=12), (group B: 4)]. Postoperative pain scores had significant higher difference in simple closure than figure-of-eight technique. From all patients, three cases with figure-of-eight and seven cases with simple wire closure had chest re-exploration after surgery. Chest re-exploration in group of figure-of-eight was lower than group of simple closure significantly (p=0.03). Postoperative utilization of inotropic agents, mediastinitis, cerebrovascular accident (CVA) and atrial fibrillation (AF) had not significant differences between both techniques. Conclusion. These findings show that figure-of-eight sternal wire closure technique can reduce postoperative pain scores and chest re-exploration significantly in diabetic patients with severe obesity.
    VL  - 1
    IS  - 3
    ER  - 

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Author Information
  • Department of Cardiac Surgery, Afshar Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran

  • Yazd Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran

  • Yazd Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran

  • Yazd Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran

  • Non-Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran

  • Yazd Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran

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