Sternal Staple: Simple and Rapid Device for Closure of Median Sternotomy Yousif D. Al-Naaman, M.D., and Muhamad S. Al-Ani, M.D.
ABSTRACT A new device for rapid and secure closure of median sternotomy has been developed, clinically proved, and found to be an excellent additional tool for the armamentarium of the thoracic surgeon.
m m
Closure of a median sternotomy by peristernal or transsternal surgical steel wiring is a tedious and time-consuming method [ 2 , 3, 81. Injuries and complications to underlying or neighboring structures have been documented [l, 5, 6, 71. Likewise, complications have been reported Fig 1. Staples are shown in two lengths and three with the use of other materials [4, 71. depths. The speed and ease of closure and rigid fixation afforded by the new staple described here make it superior to all other methods available. The frame of the stainless steel staple*consists of two cone-shaped prongs with hooks for rigid fixation and stabilization in the sternum. Three sizes are available in two lengths and depths (Fig 1):a large size for the manubrium, a medium size for the middle of the sternum, and a small size for the lower portion of the sternum. A special holder and staple driver are designed to facilitate fixing the staple to the cortex of the Fig2. Staple holder (top)andstapledriver sternum before it is hammered deep into the (bottom). bone (Fig 2 ) . Four or five staples are usually needed for each closure and take only a few minutes to fix (Fig 3). The medium- and smallsized staples may be used in children. This device has been used by our department for the past year in 32 patients. Thus far, no complications have been encountered and none of the staples have loosened. The staple seems to fix the sternum in a solid state, and we are very satisfied with it.
rnm
From the Department of Thoracic and Cardiovascular Surgery, University of Baghdad College of Medicine, Baghdad, Iraq. Accepted for publication June 5, 1975. Address reprint requests to Dr. Al-Naaman, University of Baghdad College of Medicine, Baghdad, Iraq. *Heinrich C. Ulrich, Ulm-Donau, West Germany.
170
Fig3. Thefinal fixation.
171 How to Do It: Al-Naaman and Al-Ani: Sternal Staple
References 1. Brown HA, Braimbridge MV, Panagopoulos P, et al: The complications of median sternotomy. J Thorac Cardiovasc Surg 58:189, 1969 2. Cabrol C, Lepicard P, Laughlin L A new sternal perforator for closure of midline sternotomy. J Thorac Cardiovasc Surg 14:547, 1973 3. Lemmon WM: Sternal approximator: a new instrument. J Thorac Cardiovasc Surg 43:276, 1962 4. LeVeen HL, Piccone VA: Nylon-band chest closure. Arch Surg 96:39, 1968 5. Martin A, Ross BA, Braimbridge MV: Peristernal
wiring in closure of median sternotomy: false aneurysm of the internal mammary artery. J Thorac Cardiovasc Surg 66:145, 1973 6. Sanfelippo PM, Danielson GK: Complications associated with median sternotomy. J Thorac Cardiovasc Surg 63:419, 1972 7. Sanfelippo PM, Danielson GK: Nylon bands for closure of median sternotomy incisions. Ann Thorac Surg 13:404, 1972 8. Timmes JJ, Wolvek S, Fernando M, et al: A new method of sternal approximation. Ann Thorac Surg 15:544, 1973
ABSTRACT A new device for rapid and secure closure of median sternotomy has been developed, clinically proved, and found to be an excellent additional tool for the armamentarium of the thoracic surgeon.
m m
Closure of a median sternotomy by peristernal or transsternal surgical steel wiring is a tedious and time-consuming method [ 2 , 3, 81. Injuries and complications to underlying or neighboring structures have been documented [l, 5, 6, 71. Likewise, complications have been reported Fig 1. Staples are shown in two lengths and three with the use of other materials [4, 71. depths. The speed and ease of closure and rigid fixation afforded by the new staple described here make it superior to all other methods available. The frame of the stainless steel staple*consists of two cone-shaped prongs with hooks for rigid fixation and stabilization in the sternum. Three sizes are available in two lengths and depths (Fig 1):a large size for the manubrium, a medium size for the middle of the sternum, and a small size for the lower portion of the sternum. A special holder and staple driver are designed to facilitate fixing the staple to the cortex of the Fig2. Staple holder (top)andstapledriver sternum before it is hammered deep into the (bottom). bone (Fig 2 ) . Four or five staples are usually needed for each closure and take only a few minutes to fix (Fig 3). The medium- and smallsized staples may be used in children. This device has been used by our department for the past year in 32 patients. Thus far, no complications have been encountered and none of the staples have loosened. The staple seems to fix the sternum in a solid state, and we are very satisfied with it.
rnm
From the Department of Thoracic and Cardiovascular Surgery, University of Baghdad College of Medicine, Baghdad, Iraq. Accepted for publication June 5, 1975. Address reprint requests to Dr. Al-Naaman, University of Baghdad College of Medicine, Baghdad, Iraq. *Heinrich C. Ulrich, Ulm-Donau, West Germany.
170
Fig3. Thefinal fixation.
171 How to Do It: Al-Naaman and Al-Ani: Sternal Staple
References 1. Brown HA, Braimbridge MV, Panagopoulos P, et al: The complications of median sternotomy. J Thorac Cardiovasc Surg 58:189, 1969 2. Cabrol C, Lepicard P, Laughlin L A new sternal perforator for closure of midline sternotomy. J Thorac Cardiovasc Surg 14:547, 1973 3. Lemmon WM: Sternal approximator: a new instrument. J Thorac Cardiovasc Surg 43:276, 1962 4. LeVeen HL, Piccone VA: Nylon-band chest closure. Arch Surg 96:39, 1968 5. Martin A, Ross BA, Braimbridge MV: Peristernal
wiring in closure of median sternotomy: false aneurysm of the internal mammary artery. J Thorac Cardiovasc Surg 66:145, 1973 6. Sanfelippo PM, Danielson GK: Complications associated with median sternotomy. J Thorac Cardiovasc Surg 63:419, 1972 7. Sanfelippo PM, Danielson GK: Nylon bands for closure of median sternotomy incisions. Ann Thorac Surg 13:404, 1972 8. Timmes JJ, Wolvek S, Fernando M, et al: A new method of sternal approximation. Ann Thorac Surg 15:544, 1973
