title: Placement of trans-sternal wires according to an ellipsoid pressure vessel model of sternal forces.
abstract: Dehiscence of median sternotomy wounds remains a clinical problem. Wall forces in thin-walled pressure vessels can be calculated by membrane stress theory. An ellipsoid pressure vessel model of sternal forces is presented together with its application for optimal wire placement in the sternum. Sternal forces were calculated by computational simulation using an ellipsoid chest wall model. Sternal forces were correlated with different sternal thicknesses and radio-density as measured by computerized tomography (CT) scans of the sternum. A comparison of alternative placement of trans-sternal wires located either at the levels of the costal cartilages or the intercostal spaces was made. The ellipsoid pressure vessel model shows that higher levels of stress are operative at increasing chest diameter (P < 0.001). CT scans show that the thickness of the sternal body is on average 3 mm and 30% thicker (P < 0.001) and 53% more radio-dense (P < 0.001) at the costal cartilage levels when compared with adjacent intercostal spaces. This results in a decrease of average sternal stress from 438 kPa at the intercostal space level to 338 kPa at the costal cartilage level (P = 0.003). Biomechanical modelling suggests that placement of trans-sternal wires at the thicker bone and more radio-dense level of the costal cartilages will result in reduced stress.
authors.affiliation: Department of Cardiothoracic Surgery, Mater Dei Hospital, Msida, Malta. aaron.casha@um.edu.mt
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Casha
authors.forename: Alex
authors.initials: A
authors.lastname: Manché
authors.forename: Marilyn
authors.initials: M
authors.lastname: Gauci
authors.forename: Marie-Therese
authors.initials: MT
authors.lastname: Camilleri-Podesta
authors.forename: Pierre
authors.initials: P
authors.lastname: Schembri-Wismayer
authors.forename: Zdenka
authors.initials: Z
authors.lastname: Sant
authors.forename: Ruben
authors.initials: R
authors.lastname: Gatt
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Grima
mesh_terms: D000328:Adult; D001174:Arthrodesis / Q000379:methods*; D001696:Biomechanical Phenomena; D001864:Bone Wires; D006348:Cardiac Surgical Procedures / Q000379:methods; D003198:Computer Simulation; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D011312:Pressure; D056346:Sternotomy / Q000009:adverse effects* / Q000379:methods; D013249:Sternum / Q000503:physiopathology* / Q000601:surgery; D013314:Stress, Mechanical; D013529:Surgical Wound Dehiscence / Q000503:physiopathology / Q000601:surgery*