What is the impact of a previously failed Robicsek repair in the subsequent treatment of sternal dehiscence with thermoreactive nitinol clips?

BACKGROUND: In this study, we conducted a retrospective review of patients at our institution with noninfectious sternal dehiscence (NISD) after median sternotomy who received thermoreactive nitinol clips (TRNC) treatment during a 10-year period. The purpose of the study was to analyze the impact of previous Robicsek repair on the later treatment of sternal dehiscence with TRCN to establish which method was better in high-risk patients with NISD. METHODS: Between December 2009 and January 2020, out of 283 patients with NISD who underwent refixation, we studied 34 cases who received TRNC treatment. We divided these 34 cases into two groups: patients who had a previously failed Robicsek procedure before TRNC treatment (group A, n = 11) and patients who had been directly referred to TRCN treatment (group B, n = 23). High-risk patients were defined as those having three or more risk factors. RESULTS: Postoperative complication rate was significantly higher in group A (p = .026). Hospitalization duration was significantly longer in group A due to the higher complication rate (p = .001). Operative time was significantly shorter and blood loss was significantly lower in group B (p = .001). CONCLUSION: The Robicsek procedure is considered an effective method in the treatment of NISD but, in case of its failure, subsequent TRNC treatment might become cumbersome in high-risk patients. In our study, a previously failed Robicsek procedure caused significantly higher morbidity, additional operative risk and lower success rate in later TRNC treatment of high-risk cases. Ultimately, we speculate that a direct TRNC treatment for NISD is favorable in high-risk patients.

Sternal Complications Following Coronary Artery Bypass Grafting and Robicsek Repair: Comprehensive Sternal Reconstruction With Sternal Plating and the Use of Novel Biologic Therapies.

Sternal non-union and fractured sternal wires are rare but devastating complications of median sternotomy for cardiac surgery, and these can lead to chronic pain, instability, and impaired quality of life. Patients may present with various symptoms such as clicking sensations, chest wall discomfort, and even respiratory difficulties. The underlying causes are multifactorial, including patient comorbidities, surgical technique, and postoperative management. The treatment options range from conservative measures to complex surgical interventions, such as sternal debridement, rewiring, and reconstruction with rigid fixation systems. Novel therapeutic technologies, including amniotic membranes and platelet-rich plasma, have shown promise in promoting wound healing and reducing complications in these challenging cases. We present the case of a 58-year-old male who underwent coronary artery bypass grafting (CABG) and subsequently developed sternal dehiscence requiring Robicsek repair. Despite undergoing this procedure, the patient experienced poor sternal healing, and hence he was referred to our center, presenting with shortness of breath, pain due to fractured sternal wires, and sternal non-union. The patient underwent a complex sternal reconstruction involving redo full median sternotomy, removal of sternal wires, and sternal plating, along with the application of amniotic membranes and platelet-rich plasma to the sternal wound. The procedure successfully stabilized the sternum. This report highlights the benefits of a multifaceted approach to addressing repeated sternal breakdown following CABG and the potential therapeutic benefits of novel technologies in promoting wound healing.