title: Sternal wrapping for the prevention of sternal morbidity in elderly osteoporotic patients undergoing median sternotomy.
abstract: Osteoporosis, a major risk factor for sternum-related morbidity after median sternotomy, is quite prevalent among the elderly. In this prospective study, we investigated the potential of sternal protection by use of the "sternal wrapping method" in elderly osteoporotic patients who were undergoing median sternotomy.For this study, we chose 100 elderly osteoporotic patients who were scheduled to undergo median sternotomy. During surgery, we wrapped the sternal edges with polyvinyl chloride tubing in 50 patients (group 1) and omitted the sternal wrapping in the remaining 50 patients (group 2). We then compared the groups with regard to postoperative pain, bleeding, early and late sternum-related morbidity, sternal fractures, and duration of hospitalization.Sternal wrapping was associated with fewer sternal fractures, less chest pain, and shorter hospital stays. Overall sternal morbidity was significantly less common among patients with sternal wrapping (4% vs. 20%, P = 0.03); however, the difference in individual rates for early and late dehiscence or deep sternal infection did not reach statistical significance.Sternal wrapping using polyvinyl chloride tubes provides mechanical protection and, apparently, less postoperative chest pain and shorter hospitalizations. Probably, it reduces sternum-related complications, particularly in high-risk patients. Its benefits, however, should be confirmed in larger studies.
authors.affiliation: Division of Cardiovascular Surgery, Medicana Hospitals Camlica, 34764 Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Kirbas
authors.forename: Sezai
authors.initials: S
authors.lastname: Celik
authors.forename: Onur
authors.initials: O
authors.lastname: Gurer
authors.forename: Yahya
authors.initials: Y
authors.lastname: Yildiz
authors.forename: Omer
authors.initials: O
authors.lastname: Isik
mesh_terms: D000367:Age Factors; D000368:Aged; D015519:Bone Density; D002637:Chest Pain / Q000209:etiology / Q000517:prevention & control; D004867:Equipment Design; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D010024:Osteoporosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011143:Polyvinyl Chloride; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects / Q000401:mortality; D013523:Surgical Equipment; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality
chemical_list: D011143:Polyvinyl Chloride