The Heart Surgery Forum, Volume 7, Issue 4

A New Technical Approach for Sternal Closure with Suture Anchors (Dogan Technique)

Omer Faruk Dogan, MD,¹ Ali Oznur, MD,² Metin Demircin, MD³

¹Hacettepe University Faculty of Medicine, Department of Cardiovascular Surgery; ²Ankara Guven Hospital, Department of Orthopedic Surgery; ³Hacettepe University Faculty of Medicine, Department of Thoracic and Cardiovascular Surgery, Ankara, Turkey

ABSTRACT

Objectives: Various methods for sternal approximation have been described previously. Some patients undergoing these procedures are at risk for sternal dehiscence and mediastinitis. We used a different method, with a suture anchor system, for median sternotomy closure as an alternate technique in patients with a high risk of postoperative sternal dehiscence and sternal nonunion.

Material and Method: Suture anchor systems have been developed principally for the fixation of tendons or ligaments to the bone. We first used the suture anchor system for median sternotomy closure, although it has been frequently used in various orthopedic surgical procedures. In this report, we describe the use, after fresh cadaveric tests, of an alternative technique in a patient undergoing coronary artery bypass grafting.

Results: There were no complications due to the suture anchor device, and successful application was performed for sternotomy fixation after surgical procedure in a patient. The standard techniques have several disadvantages, such as osteomyelitis, chondritis, cutting into the sternum and sternal dehiscence, prolonged hospitalization, and increased mortality and morbidity due to the listed complications, but these devices may protect the wire from cutting into the sternal bone.

Conclusion: We propose suture anchors for reapproximation of the sternum to decrease the complications related to surgical steel wires. We therefore consider this technique to be easy, safe, and effective in patients with diabetes mellitus or severe osteoporosis considered to have risk for sternal dehiscence postoperatively. Another advantage of this suture system is that the titanium wire makes it more magnetic resonance compatible than systems using surgical steel wire.

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