Median Sternotomy Closure Techniques Flashcards
What are the three methods used for Sternal Closure?
- Plates and Screws (adults only)
- Stainless Steel Suture
- 1 Vicryl (neonates only- bones will fuse over time)
What size of Sternal Wire is used to suture the Sternum in adult patients?
5 Sternal Wire
How far down must you twist Sternal Wires?
Until the twist hits bone
How do you prevent air knots with Sternal Wires?
Pull up between each twist
What is the last step before closing tissue during a Sternal Closure?
Tucking twisted end of Sternal Wire to prevent injury
What suture is used to close the Pectoralis Fascia during a Sternal Closure?
2-0 Vicryl (CT1 Needle)
Why is the Pectoralis Fascia sutured during a Sternal Closure?
To provide extra protection
What suture is used to close the Dermis during a Sternal Closure?
3-0 Vicryl (CT1 Needle)
What suture is used to close the Skin during a Sternal Closure?
4-0 Monocryl (PS2 Needle)
What dressings are used after a Sternal Closure?
- Dermabond
- Aquacel Ag
What are the benefits of using Aquacel Ag as a dressing after a Sternal Closure?
- Silver impregnated material (antibacterial properties)
- Can stay on patient for 7 days
- Hypogenic adhesive (Easy to stick/remove)
What are the causes for Sternal Wound Dehiscence?
- Poor suture technique
- Infection
- Patient comorbidities
- Harvested Internal Thoracic Artery (less blood flow to midline)
What is a method of preventing Sternal Wound Dehiscence?
Using Negative Pressure Wound Therapy on the closed incision
How does Negative Pressure Wound Therapy prevent Sternal Wound Dehiscence?
- Pulls away any seromas (less bacteria)
- Pushes down on incision helping prevent dehiscence
How is a Sternal Wound Dehiscence fixed when Primary Wound Closure doesn’t work?
If patient has excess tissue:
-Pectoralis Major muscle flap
If patient does not have excess tissue:
-Rectus Abdominis muscle flap
