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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 2002 October;43(5):741-6

lingua: Inglese

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


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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.

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