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Thorac Cardiovasc Surg 2020; 68(08): 737-742
DOI: 10.1055/s-0038-1667326
Original Cardiovascular

Fibrin-Coated Collagen Fleece Seems to Prevent Sternal Instability after Cardiac Surgery: A Matched Pair Data Analysis

Peter Roth
1   Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
,
Jenna Stella
1   Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
,
Bernd Niemann
1   Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
,
Philippe Grieshaber
1   Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
,
Rainer Roehrig
2   Department of Medical Informatics, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
,
Andreas Böning
1   Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
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Abstract

Background To examine if fibrin-coated collagen fleece (Tachosil) interferes with bone and wound healing when it is used on the cut surface of the sternum after median sternotomy.

Methods A total of 25 patients with osteoporotic sternal disorders were treated with fibrin-coated collagen fleece at the cut surface of the sternum after median sternotomy (therapy group). We compared the occurrence of impaired wound healing and sternal instability, reoperation rate, and 30-day mortality with a control group of 25 case-matched patients. After matching for age, gender, and risk factors for sternal instability (diabetes mellitus, osteoporosis, body mass index, nicotine consumption), both groups were comparable.

Results Sternal instability occurred in one (4%) patient in the study group and in five (20%) patients in the control group. Impaired wound healing occurred in one (4%) patient in the therapy group and two (8%) patients in the control group. Reoperation was necessary in four (16%) patients in the therapy group and 6 (24%) patients in the control group. The 30-day mortality occurred in six (24%) patients in the therapy group and four (16%) patients in the control group.

Conclusions The use of fibrin-coated collagen fleece on the cut surface of the sternum in patients with osteoporosis does not impair bone and wound healing. Furthermore, it seems to result in less sternal instability. A larger prospective study is necessary to verify the results of this explorative study.

Keywords

sternal instability - fibrin-coated collagen fleece - bone healing - wound healing


Publication History

Received: 04 March 2018

Accepted: 26 June 2018

Article published online:
28 August 2018

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Baskett RJ, MacDougall CE, Ross DB. Is mediastinitis a preventable complication? A 10-year review. Ann Thorac Surg 1999; 67 (02) 462-465
    CrossrefPubMedSearch in Google Scholar
  • 2 Furnary AP, Zerr KJ, Grunkemeier GL, Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 1999; 67 (02) 352-360 , discussion 360–362
    CrossrefPubMedSearch in Google Scholar
  • 3 Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 2001; 20 (06) 1168-1175
    CrossrefPubMedSearch in Google Scholar
  • 4 Jenny NS, Arnold AM, Kuller LH, Tracy RP, Psaty BM. Serum amyloid P and cardiovascular disease in older men and women: results from the Cardiovascular Health Study. Arterioscler Thromb Vasc Biol 2007; 27 (02) 352-358
    CrossrefPubMedSearch in Google Scholar
  • 5 Abboud CS, Wey SB, Baltar VT. Risk factors for mediastinitis after cardiac surgery. Ann Thorac Surg 2004; 77 (02) 676-683
    CrossrefPubMedSearch in Google Scholar
  • 6 El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg 1996; 61 (03) 1030-1036
    CrossrefPubMedSearch in Google Scholar
  • 7 Loop FD, Lytle BW, Cosgrove DM. et al. J. Maxwell Chamberlain memorial paper. Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care. Ann Thorac Surg 1990; 49 (02) 179-186 , discussion 186–187
    CrossrefPubMedSearch in Google Scholar
  • 8 Vallely MP, Edelman JJB, Wilson MK. Bilateral internal mammary arteries: evidence and technical considerations. Ann Cardiothorac Surg 2013; 2 (04) 570-577
    PubMedSearch in Google Scholar
  • 9 Bitkover CY, Gårdlund B. Mediastinitis after cardiovascular operations: a case-control study of risk factors. Ann Thorac Surg 1998; 65 (01) 36-40
    CrossrefPubMedSearch in Google Scholar
  • 10 Bajardi G, Pecoraro F, Mirabella D. Efficacy of TachoSil patches in controlling Dacron suture-hole bleeding after abdominal aortic aneurysm open repair. J Cardiothorac Surg 2009; 4: 60
    CrossrefPubMedSearch in Google Scholar
  • 11 Rousou JA. Use of fibrin sealants in cardiovascular surgery: a systematic review. J Card Surg 2013; 28 (03) 238-247
    CrossrefPubMedSearch in Google Scholar
  • 12 Agus GB, Bono AV, Mira E. et al. Hemostatic efficacy and safety of TachoComb in surgery. Ready to use and rapid hemostatic agent. Int Surg 1996; 81 (03) 316-319
    PubMedSearch in Google Scholar
  • 13 Maisano F, Kjaergård HK, Bauernschmitt R. et al. TachoSil surgical patch versus conventional haemostatic fleece material for control of bleeding in cardiovascular surgery: a randomised controlled trial. Eur J Cardiothorac Surg 2009; 36 (04) 708-714
    CrossrefPubMedSearch in Google Scholar
  • 14 Bhatti F, Dunning J. Does liberal use of bone wax increase the risk of mediastinitis?. Interact Cardiovasc Thorac Surg 2003; 2 (04) 410-412
    CrossrefPubMedSearch in Google Scholar
  • 15 Mair H, Kaczmarek I, Oberhoffer M, Groetzner J, Daebritz S, Reichert B. Surgical Nu-Knit hemostat for bleeding control of fragile sternum. J Thorac Cardiovasc Surg 2005; 130 (02) 605-606
    CrossrefPubMedSearch in Google Scholar
  • 16 Vestergaard RF, Jensen H, Vind-Kezunovic S, Jakobsen T, Søballe K, Hasenkam JM. Bone healing after median sternotomy: a comparison of two hemostatic devices. J Cardiothorac Surg 2010; 5 (01) 117
    CrossrefPubMedSearch in Google Scholar
  • 17 Lammers RL. Soft tissue foreign bodies. Ann Emerg Med 1988; 17 (12) 1336-1347
    CrossrefPubMedSearch in Google Scholar
  • 18 Sung KY, Lee SY. A chronic, nonhealing wound of the finger caused by polypropylene suture material. Wounds 2015; 27 (07) E16-E19
    PubMedSearch in Google Scholar
  • 19 Satta J, Lahtinen J, Räisänen L, Salmela E, Juvonen T. Options for the management of poststernotomy mediastinitis. Scand Cardiovasc J 1998; 32 (01) 29-32
    CrossrefPubMedSearch in Google Scholar
  • 20 Kirbas A, Celik S, Gurer O, Yildiz Y, Isik O. Sternal wrapping for the prevention of sternal morbidity in elderly osteoporotic patients undergoing median sternotomy. Tex Heart Inst J 2011; 38 (02) 132-136
    PubMedSearch in Google Scholar