Mechanical analysis of midline sternotomy wound closure

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Presentation transcript:

Mechanical analysis of midline sternotomy wound closure Walter E. McGregor, MDa, Dennis R. Trumble, MSb, James A. Magovern, MDb The Journal of Thoracic and Cardiovascular Surgery Volume 117, Issue 6, Pages 1144-1150 (June 1999) DOI: 10.1016/S0022-5223(99)70251-5 Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 1 Experimental setup used to apply traction forces to the sternums of intact human cadavers. A rigid enclosure fashioned from steel pipe (0.85-inch outer diameter) was used to provide stable anchoring points for sternal traction in 3 mutually orthogonal directions: lateral (shown here), rostral-caudal, and anterior-posterior. Force was applied through steel cables secured to the second, fourth, and sixth ribs at their insertion points and adjusted via a turnbuckle mechanism. Bone fracture was prevented by pressing each rib between 2 brass plates with the use of a small metal hose clamp (to which the cable was attached). Sternal motion was monitored by means of 4 pairs of sonomicrometry crystals and tension was measured via an S-beam load cell. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 1144-1150DOI: (10.1016/S0022-5223(99)70251-5) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 2 Schematic portrayal of traction forces applied across the sternum: left, lateral; center, anterior-posterior; and right, rostral-caudal. Arrows represent the force vectors delivered by the sternal traction apparatus depicted in Fig 1. Note that anterior-posterior motion is induced by a single vertical force vector applied to one side of the sternum. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 1144-1150DOI: (10.1016/S0022-5223(99)70251-5) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 3 Regional sternal motion plotted against lateral (A), anterior-posterior (B), and rostral-caudal (C) traction forces. Open symbols represent the most cephalad and most caudal crystal pairs. Data are from the most robust model of sternal closure tested (male cadaver). The Journal of Thoracic and Cardiovascular Surgery 1999 117, 1144-1150DOI: (10.1016/S0022-5223(99)70251-5) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 4 Sternal motion plotted against intrathoracic pressure during simulated Valsalva force. Open symbols represent the most cephalad and most caudal crystal pairs. Data are from the most robust model of sternal closure tested (male cadaver). The Journal of Thoracic and Cardiovascular Surgery 1999 117, 1144-1150DOI: (10.1016/S0022-5223(99)70251-5) Copyright © 1999 Mosby, Inc. Terms and Conditions