Median sternotomy: Comparative testing of braided superelastic and monofilament stainless steel sternal sutures

Abstract

A new device to reduce the risk of post-operative complications following median sternotomy is proposed, made of a superelastic shape memory alloy and called a braided tubular superelastic (BTS) suture. This study compares the viability of the BTS suture with that of the standard monofilament stainless steel (MSS) suture. A custom test bench was developed to perform comparative testing of the two sternal closure systems. Sternal models made of polyurethane were closed using common wiring configurations. Static and dynamic tensile separation forces, up to a maximum of 1200 N, were then applied to the closed sternums. The MSS and BTS sutures are compared in terms of the force required to open completely the sternum, the compression force at the sternum midline, and the permanent sternum opening. With a smaller sternum opening and a higher tensile separation force, the MSS suture showed greater rigidity than the BTS suture. The BTS suture, however, displayed a better capacity to reapply compression forces at the sternum midline following the repetitive application and release of tensile separation forces. These results confirm the potential of the BTS suture technology, but further studies using cadaveric sterna are needed to attest definitely to the benefits of using the BTS suture to improve bone healing.

Keywords

sternotomy sternal closure coughing shape memory alloy

Get full access to this article

View all access options for this article.

References

Casha

A. R.

Gauci

Yang

Saleh

Kay

P. H.

Cooper

G. J.

‘Fatigue testing median sternotomy closures.’

Eur. J. Cardio-thoracic Surg. 19 (3) (2001): 249–253

Robicsek

Daugherty

H. K.

Cook

J. W.

‘The prevention and treatment of sternum separation following open-heart surgery.’

J. Thoracic Cardiovascular Surg. 73 (2) (1977): 267–268

Sargent

L. A.

Seyfer

A. E.

Hollinger

Hinson

R. M.

Graeber

G. M.

‘The healing sternum: A comparison of osseous healing with wire versus rigid fixation.’

Ann. Thoracic Surg. 52 (3) (1991): 490–494

Casha

A. R.

Yang

Kay

P. H.

Saleh

Cooper

G. J.

‘A biomechanical study of median sternotomy closure techniques.’

Eur. J. Cardio-thoracic Surg. 15 (3) (1999): 365–369

McGregor

W. E.

Trumble

D. R.

Magovern

J. A.

‘Mechanical analysis of midline sternotomy wound closure.’

J. Thoracic Cardiovascular Surg. 117 (6) (1999): 1144–1145

McCool

F. D.

‘Global physiology and pathophysiology of cough: ACCP evidence-based clinical practice guidelines.’

Chest 129 (1 Suppl) (2006): 48S-53S.

Duerig

Pelton

Stockel

‘Superelastic Nitinol for Medical Devices.’

Med. Plast. Bromater. Mag. (1997): 1–14

F 1350. ‘Standard specification for wrought 18 Chromium–14 Nickel–2.5 molybdenum stainless steel surgical fixation wire (UNS S31673).’ In Annual book of ASTM standards, 2001 pp. 684–685 (American Society for Testing and Materials Philadelphia, Pennsylvania).

Trumble

D. R.

McGregor

W. E.

Magovern

J. A.

‘Validation of a bone analog model for studies of sternal closure.’

Ann. Thoracic Surg. 74 (3) (2002): 739–744

10.

Chartrand

Brailovski

Baril

‘Test bench and methodology for sternal closure system testing.’

Expl Techqs (2008): (in press)

11.

Cohen

D. J.

Griffin

L. V.

‘A biomechanical comparison of three sternotomy closure techniques.’

Ann. Thoracic Surg. 73 (2) (2002): 563–568

12.

Dasika

U. K.

Trumble

D. R.

Magovern

J. A.

‘Lower sternal reinforcement improves the stability of sternal closure.’

Ann. Thoracic Surg. 75 (5) (2003): 1618–1621

13.

Losanoff

J. E.

Collier

A. D.

Wagner-Mann

C. C.

Richman

B. W.

Huff

Hsieh

F.-H.

Diaz-Arias

Jones

J. W.

‘Biomechanical comparison of median sternotomy closures.’

Ann. Thoracic Surg. 77 (1) (2004): 203–209

14.

Losanoff

J. E.

Foerst

J. R.

Huff

Richman

B. W.

Collier

A. D.

Hsieh

F. H.

Lee

Jones

J. W.

‘Biomechanical porcine model of median sternotomy closure.’

J. Surg. Res. 107 (1) (2002): 108–112

15.

Ozaki

Buchman

S. R.

Iannettoni

M. D.

Frankenburg

E. P.

‘Biomechanical study of sternal closure using rigid fixation techniques in human cadaver.’

Ann. Thoracic Surg. 65 (6) (1998): 1660–1665

16.

Pai

Gunja

Dupak

McMahon

Coburn

Lalikos

Dunn

R. M.

Francalancia

Pins

G. D.

Billiar

K. L.

‘A mechanical study of rigid plate configurations for sternal fixation.’

Ann. Biomed. Engng 35 (5) (2007): 808–816

17.

Pai

Gunja

N. J.

Dupak

E. L.

McMahon

N. L.

Roth

T. P.

Lalikos

J. F.

Dunn

R. M.

Francalancia

Pins

G. D.

Billiar

K. L.

‘In vitro comparison of wire and plate fixation for midline sternotomies.’

Ann. Thoracic Surg. 80 (3) (2005): 962–968

18.

Dasika

U. K.

Magovern

J. A.

‘Lower sternal reinforcement to improve median sternotomy closure: Reply.’

Ann. Thoracic Surg. 77 (6) (2004): 2261–2262

19.

Baril

Brailovski

Terriault

Cartier

‘Feasibility study of a new sternal closure device using tubular braided superelastic Nitinol structures.’ In Proceedings of the Conference on Materials and processes for medical devices, Boston, Massachusetts, USA, 14–16 November 2005 pp. 243–248 (ASM International, West Conshohocken Pennsylvania).

20.

Baril

Brailovski

Chartrand

Terriault

Cartier

‘In-vitro testing of a new superelastic sternum closure component.’ In Proceedings of the International Conference on Shape memory and superelastic technologies (SMST-2007), Tsukuba, Japan, 3–5 December 2007 (in press).