Ann Thorac Surg
References 1. Bachet J, Goudot 8 , Teodori G, et al. Surgery of type A acute dissections with gelatine-resorcine-formol biological glue: a twelve year experience. J Cardiovasc Surg 1990;31:263-73. 2. Laas J, Jurmann MJ, Heinemann M, Borst HG. Advances in aortic arch surgery. Ann Thorac Surg 1992;53:227-32. 3. Zeplin HE, Weingartner J, Berger A, Stegmann TH. Surgical treatment of acute aortic dissections with aid of gelatine resorcine formol glue. Fifth Annual Meeting of the Mediterranean Association of Cardiology and Cardiac Surgery, Alexandria, Egypt, Sep 23-27, 1991, Abstract Volume. Cairo: El Tobgy Press, 1991:233. 4. Zeplin HE, Weingartner J, Stegmann TH. Replacement of the thoracic aorta: improvement of surgical results by use of gelatine resorcin formol glue. J Cardiovasc Surg 1992;33:77-8.
Modified Retractor to Prevent Peripheral Nerve Injury To the Editor: I read with interest the correspondence from Dr Briffa and associates [I] in which they describe the disadvantages of a one-stemmed versus a two-stemmed system to retract the sternum for internal mammary artery harvesting. I would like to share with you our modification of the Ochsner-
Fig 2. The clamps are extended.
Favoloro sternal retractor that we have been using for the last 15 years . The modification consists of an angled bar that keeps the stems away from the patient’s arm and prevents peripheral nerve injury (Fig 1). Because the distance from the retractor to the sternum has been extended, we also added a n extension to the clamps that pull the sternum away (Fig 2). Since we started using this modification about 6 months ago, we have not had any incidents of peripheral nerve injuries. The system can be easily modified at a very low cost.
Nelson Ancalmo, M D Department of Cardiovascular Surgery Ochsner Clinic of Baton Rouge 16777 Medical Center Dr Baton Rouge, LA 70816
Fig 1. Modification of the Ochsner-Favoloro sternal retractor.
1. Briffa NP, Price C, Grotte GJ, Keenan DJ. Radial nerve injury in patients undergoing coronary artery bypass grafting. Ann Thorac Surg 1992;53:1149-50. 2. Ancalmo N, Ochsner JL. A modified sternal retractor. Ann Thorac Surg 1976;21:174.