title: Bone cement-enhanced sternal closure technique in cardiac surgery: effects on sternal union, pain and life quality.
abstract: BACKGROUND
  Median sternotomy provides excellent access to all mediastinal structures in patients undergoing conventional cardiovascular surgery. Although this incision technique is associated with relatively lower complication rates, certain complications such as the sternal dehiscence may pose serious health consequences. In this regard, considerable effort has been paid to develop techniques aiming to improve sternal healing and to enhance postoperative recovery after conventional cardiac surgery. Among these, kryptonite bone cement, a biocompatible polymer with improved mechanical properties when combined with a standard wire cerclage, represents a promising novel approach that may help prevent sternal dehiscence. In this study, the effects of this particular type of bone cement on sternal healing, postoperative pain, and quality of life have been evaluated.
  
  
  METHODS
  Kryptonite bone cement enhanced sternal closure was employed in a total of 100 patients undergoing conventional cardiac surgery between November 2009 and June 2012. Of these patients, 50 expressed their willingness to participate in this study. Each participant underwent a computerized tomography imaging for the radiological assessment of sternal healing. Pain and life quality of these patients have been evaluated by Wong-Baker faces pain scale and SF-36 health survey questionnaire, respectively.
  
  
  RESULTS
  Mean duration of follow-up was 20.14 ± 7.36 months (range: 10-32). Mean age and body mass index were 71.32 ± 7.23 years (range: 55-85) and 28.34 ± 2.62 (21-34) kg/m2, respectively. Elderly patients (≥70), females and those with chronic obstructive pulmonary disease (COPD) comprised 64%, 26% and 40% of the study population, respectively. No patients had findings suggestive of dehiscence on CT images. No patients reported severe pain (i.e. all patients had a Wong-Baker faces pain scale score <4). Elderly (≥ 70 yr) subjects had better quality of life scores as compared to the remaining group of patients (< 70 yr) according to SF-36 Health Survey results. Vitality and emotional role scores were lower (63.5 ± 25.5, p = 0.018 and 41.7 ± 23.3, p = 0.001, respectively) in female patients. Patients with COPD had lower quality of life scores than those without COPD, particularly with respect to general health scores (73.3 ± 18.5; p = 0.012).
  
  
  CONCLUSIONS
  Kryptonite bone cement, when combined with a standard wire cerclage, enhances mechanical strength, prevents sternal dehiscence, reduces postoperative pain and improves quality of life after conventional cardiac surgery. Long-term studies are warranted to better define the role of kryptonite bone cement in the prevention of sternal dehiscence.
authors.forename: Zehra
authors.initials: Z
authors.lastname: Bayramoglu
authors.forename: Yasemen
authors.initials: Y
authors.lastname: Durak
authors.forename: Muhammed
authors.initials: M
authors.lastname: Bayram
authors.forename: Onur Levent
authors.initials: OL
authors.lastname: Ulusoy
authors.forename: Barıs
authors.initials: B
authors.lastname: Caynak
authors.forename: Ertan
authors.initials: E
authors.lastname: Sagbas
authors.forename: Belhan
authors.initials: B
authors.lastname: Akpınar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001864:Bone Wires; D006348:Cardiac Surgical Procedures; D002368:Castor Oil / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011108:Polymers / Q000627:therapeutic use*; D011788:Quality of Life; D056346:Sternotomy / Q000379:methods*; D013249:Sternum / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D014945:Wound Healing
chemical_list: C552291:Kryptonite bone cement; D011108:Polymers; D002368:Castor Oil
references.citation: Ann Thorac Surg. 1991 Nov;52(5):1179-80
references.pmid: 1953149
references.citation: Ann Thorac Surg. 2011 Oct;92(4):1444-50
references.pmid: 21958795
references.citation: Clin Orthop Relat Res. 1979 May;(140):12-6
references.pmid: 477062
references.citation: J Thorac Cardiovasc Surg. 1972 Oct;64(4):596-610
references.pmid: 4562531
references.citation: Arch Intern Med. 2010 Dec 13;170(22):1979-86
references.pmid: 21149754
references.citation: Surgery. 1988 Nov;104(5):899-904
references.pmid: 3187903
references.citation: Ann Thorac Surg. 2010 Sep;90(3):979-85
references.pmid: 20732527
references.citation: Ann Thorac Surg. 1984 Oct;38(4):415-23
references.pmid: 6385892
references.citation: Ann Thorac Surg. 1978 Nov;26(5):421-6
references.pmid: 380487
references.citation: J Thorac Cardiovasc Surg. 1982 Jun;83(6):937-9
references.pmid: 7087524
references.citation: Ann Thorac Surg. 1999 Sep;68(3):858-63
references.pmid: 10509974
references.citation: Pediatr Nurs. 1988 Jan-Feb;14(1):9-17
references.pmid: 3344163
references.citation: Eur J Cardiothorac Surg. 2000 Nov;18(5):557-64
references.pmid: 11053817
references.citation: Thorac Cardiovasc Surg. 2000 Feb;48(1):1-8
references.pmid: 10757149
references.citation: Heart Lung. 2000 Nov-Dec;29(6):401-11
references.pmid: 11080320
references.citation: Mayo Clin Proc. 2006 May;81(5):662-72
references.pmid: 16706264
references.citation: AJR Am J Roentgenol. 2003 Oct;181(4):1065-70
references.pmid: 14500232