title: Straight versus S-shaped sternotomy: a histologic study in the sheep model.
abstract: BACKGROUND
  Straight sternotomy is the most common access for open heart surgery. Techniques have been proposed for maximizing sternal stability in high-risk patients. This trend implies a growing need for newer surgical techniques. The aim of this experimental study in the sheep model is to evaluate median vs. S shaped sternotomy the feasibility of using a special device to accelerate the sternal instability and bone healing.
  
  
  METHODS
  We enrolled 31 sheep, weighing 18-30 kg. For all animals a midline skin incision was made. In group I (n = 16 animals), straight median sternotomy and in group II (n = 15 animals), S-shaped incision was marked on the periosteum of the sternum by new created device for standard S-shaped sternotomy. Sternum biopsies were performed on second surgery month for all survived animals from the sternum and the surrounding soft tissue.
  
  
  RESULTS
  No early superficial wound complications were observed. Overall mortality in the initial approach group was 19.3% (6 sheep). In group I; 3 sheep had died on first surgery day, the reason may be hemorrhage and in group II; 3 sheep developed intractable VF during surgery procedure or immediately afterwards so died. There were statistically significant differences in the scores of bone healing between group 1 and group 2 (4.2 vs.7.3, ANOVA, p < 0.001).
  
  
  CONCLUSIONS
  Our work is based on the use of a standard S-shaped sternotomy procedure on sheep sternum. In our experience with the sternal healing in the sheep model, the process of new bone formation was accelerated with S- shaped cut than straight sternotomy procedure.
authors.affiliation: Department of Cardiovascular Surgery, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey. binan@msn.com.
authors.forename: Bekir
authors.initials: B
authors.lastname: Inan
authors.affiliation: Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Istanbul, Turkey. fatihmfk@hotmail.com.
authors.forename: Fatih
authors.initials: F
authors.lastname: Kucukdurmaz
authors.affiliation: Department of Nephrology, Ankara Oncology Education and Research Hospital, Ankara, Turkey. sebnemkarakan@gmail.com.
authors.forename: Sebnem
authors.initials: S
authors.lastname: Karakan
authors.affiliation: Department of Cardiovascular Surgery, Malatya State Hospital, Malatya, Turkey. melikelif_teker@hotmail.com.
authors.forename: Melike E
authors.initials: ME
authors.lastname: Teker
authors.affiliation: Department of CAE and Methodology Development, SDM Research and Engineering, Istanbul, Turkey. canerakcan@gmail.com.
authors.forename: Caner
authors.initials: C
authors.lastname: Akcan
authors.affiliation: Department of Pathology, Ankara Oncology Education and Research Hospital, Ankara, Turkey. gulaydilek@gmail.com.
authors.forename: Gulay B
authors.initials: GB
authors.lastname: Dilek
authors.affiliation: Department of Microbiology, Cukurova University, Adana, Turkey. kdagli01@gmail.com.
authors.forename: Kenan
authors.initials: K
authors.lastname: Daglioglu
mesh_terms: D000818:Animals; D023421:Models, Animal; D012756:Sheep; D056346:Sternotomy / Q000379:methods*; D013249:Sternum / Q000601:surgery*; D014945:Wound Healing