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THE JOURNAL OF CARDIOVASCULAR SURGERY
A Journal on Cardiac, Vascular and Thoracic Surgery
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
ORIGINAL ARTICLES THORACIC SECTION
The Journal of Cardiovascular Surgery 2002 October;43(5):741-6
Sternal cyanoacrylate gluing in mediastinitis. Effects on infection, stability and bone healing
Ogus T. N. 1, Hulusi Us M. 2, Çiçek S. 1, Özkan S. 2, Yüksel Öztürk Ö. 2, Isik O. 2
1 Department of Cardiovascular Surgery, Maltepe University, Faculty of Medicine, Istanbul, Turkey
2 Department of Cardiovascular Surgery, and Anesthesiology-Reanimation, Gülhane Military Academy of Medecine, GATA, Istanbul, Turkey
Background. It is crucial to determine stability, histocompatibility and antibacterial properties of the cyanoacrylate used for sternal fixation.
Methods. Clinical study: in 17 cases of mediastinitis, debridement and rewiring the sternum, was applied as the treatment method (Group I). Eighteen cases of mediastinitis were treated with the same method added sternal cyanoacrylate gluing (Group II). A comparative study was done; the follow-up period was 36.7±4 and 18.5±6.9 months in Group I and II, respectively. Animal study: in 10 rats, upper sternotomy was done and the sternal bone was contaminated. Direct wound closure was done in 4 rats (Group A), in 6 animals, wounds were closed after applying cyanoacrylate in sternal split (Group B). In this prospective study, all rats alive were sacrificed at the 3rd and 8th weeks and sternums were examined histologically.
Results. Clinical study: in Group I, 6 patients required additional interventions due to recurrent sternal detachment and osteomyelitis (35.3%). In Group II neither osteomyelitis nor sternal detachment occurred, 3 patients required re-intervention related to cyanoacrylate histotoxicity. Hospital stay was higher in Group I than Group II (24.06±4.7 vs 14.16±3.98 days, respectively). Experimental study: all of the animals in Group A died of sepsis. In Group B all rats survived the procedure. At the 3rd week histologic evaluations showed that cyanoacrylate was not degraded, and no infection or foreign body reaction was observed. At the 8th week histologic examination showed that cyanoacrylate was completely degraded and replaced by connective tissue.
Conclusions. Cyanoacrylate is effective in diminishing sternal wound complications and related cost and hospital stay of mediastinitis.