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)

Seyed Jalil Mirhosseini; Sadegh Ali-Hassan-Sayegh; Seyed Mohammad Yousof Mostafavi-Pour-Manshadi; Nafiseh Naderi; Maryam Hadibarhaghtalab; Mohammad Reza Lotfaliani

doi:doi:10.11648/j.ijcems.20150103.12

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)

Seyed Jalil Mirhosseini, Sadegh Ali-Hassan-Sayegh, Seyed Mohammad Yousof Mostafavi-Pour-Manshadi, Nafiseh Naderi, Maryam Hadibarhaghtalab, Mohammad Reza Lotfaliani

Published in International Journal of Clinical and Experimental Medical Sciences (Volume 1, Issue 3)

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

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

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.

Cite This Article

Plain Text BibTeX RIS

APA Style

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

Copy | Download

ACS 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

Copy | Download

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

Copy | Download

@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}
}

Copy | Download

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  -

Copy | Download

Author Information

Seyed Jalil Mirhosseini

Department of Cardiac Surgery, Afshar Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
Sadegh Ali-Hassan-Sayegh

Yazd Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
Seyed Mohammad Yousof Mostafavi-Pour-Manshadi

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

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

Non-Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
Mohammad Reza Lotfaliani

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

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

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

Copy | Download

ACS 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

Copy | Download

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

Copy | Download

@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}
}

Copy | Download

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  -

Copy | Download