I've seen a lot of posts about wires used to repair the sternum after OHS, but not the use of plates. Apparently, this method helps with healing etc. Can anyone comment?
Jim
Jim
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Plate Fixation For Repair Of The Sternum
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Ross
Well-known member
News to me. Personally, I think it's a great idea, at least from what I can see.
I guess it's not new, but I never heard of it.
http://icvts.ctsnetjournals.org/cgi/content/full/5/4/336
I guess it's not new, but I never heard of it.
http://icvts.ctsnetjournals.org/cgi/content/full/5/4/336
Thanks for the link...interesting that cardiac surgeons have inexplicably resisted the move to plates. It's certainly a question I will pose to my surgeon.
Jim
Jim
I wonder if the reasons surgeons continue to use wire, is the vast majority people heal fine with wire and not that many people have complications. My questions would be how much time is added to the surgery/being under anesthesia since tieing wires is pretty quick, and if it would complicate people needing to have their chest open again for future surgeries . I wonder if more people would be botherred by the extra metal plates/screws instead of the small wire knots. I see they (ross's link) used the for the higher risk patients, which makes sense.
Hi, Jim, there are several new methods of closing the sternum after OHS. Below is a diagram of the devices used to close my chest. A link to the company's website is below that. My surgeon said he prefers Talons to Plates because Talons do not require drilling holes in the sternum. As well as holding the sternum securely closed, they were designed to reduce the potential for infection by clasping rather than piercing the bone as is necessary with both wires and plates.
http://rapidsternalclosure.com/medical/talon.php
When I first held a Talon, they seemed bulky so I asked about whether or not they would make big lumps under the skin. My Surgeon said at the time that there is a lot more tissue over the sternum than one expects and that it should not be possible to feel them easily. In fact, I can only feel mine if arch my back over a chair and then I can only feel the lower one a little.
My experience with them has actually been very positive, Jim. Having read all of the Post Op experiences in VR at the time, like everyone else, I dreaded the discomfort and was anxious about how I would feel after the AVR. When I woke up in my room on Day 2 after surgery (having been moved from the ICU during the night) I was surprised that I actually felt quite good but I was a little hesitant to move much. Shortly, a nurse came in to tell me breakfast was on the way and suggested I might feel better eating in a chair so I got out of bed. I got out of bed very gingerly expecting at any moment to feel a lot of chest pain but there wasn't any. I was bloated with fluid and stiff and very weak but there was no pain getting out of bed and moving to the chair. Breakfast was great as I watched the sun come up. Later that morning, I went for my first walk, took my first nap and then walked a little more. I was still taking pain medication every 4-6 hours through the day but I never felt that I needed it which probably just meant that the drugs were doing their job.
On day, I walked 5 times and since I didn't have a sense that my chest was painful, I stopped taking the narcotics. As it turned out, I didn't need them. My first shower that afternoon felt wonderful and by evening I noticed the food didn't seem nearly as good as it had the day before. I found that doing breathing exercises, coughing and walking were just not a problem. Altogether, I walked about half a mile and by bedtime I was very tired and my left shoulder really ached but the chest was OK. I took Tylenol before going to sleep and would have slept OK if there wasn't someone coming in to poke me every few hours just in case I should decide to become a diabetic.
Saturday morning (Day 4) that spot beneath my left shoulder blade ached all day so I kept up the Tylenol. The food seemed to be getting worse. I got a laugh from the older nurse when I asked if the food was part of a plot to get people to leave more quickly. I did some reading, walked a mile in 6 strolls and took lots of naps throughout the day. Reading still wasn't all that satisfactory because I kept going to sleep before I got very far. The MP3 player was really nice because if I went to sleep there was still music playing when I woke. The left shoulder seemed a little better by evening when my surgeon stopped by with the happy news that I could go home on Sunday. I got a chuckle from him when I asked if he was sure I was ready. He said "Your stats are good, you have little discomfort and no complications and I've heard that you are complaining about the food. Go home and recover where the food is better."
Jim, I cannot say with certainty that my experience was exclusively due to the set of Talons but when I went home on Sunday morning, the guy who had bypass surgery the same morning of my AVR (his chest was closed with wires) was still in a lot of discomfort. I have to admit that I felt somewhat guilty, as though I had not really "earned" my bear, each time I heard him getting out of bed three rooms down from me. The other fellow was 5 years younger than me, 50 lbs lighter and, yet, had a very different experience.
I went home on Sunday (Day 5) having had no difficulty coughing, sneezing, walking, etc although my left shoulder hurt for a couple of weeks longer. Seven months after my AVR I did developer costochondritis - an inflammation of the cartilage connecting the ribs to the sternum. I have wondered if this might be related to the devices but there is no way to know. Probably not, since most people who develop this condition have never even had heart surgery and no one actually knows what causes it other than suffering some type of chest injury.
You cannot prove anything based on a single experience, Jim, but the nurses who cared for me in the hospital commented several times that they could easily pick out the patients with Talons because they all used fewer drugs and were much more active. Let me know if you have questions.
Larry
http://rapidsternalclosure.com/medical/talon.php
When I first held a Talon, they seemed bulky so I asked about whether or not they would make big lumps under the skin. My Surgeon said at the time that there is a lot more tissue over the sternum than one expects and that it should not be possible to feel them easily. In fact, I can only feel mine if arch my back over a chair and then I can only feel the lower one a little.
My experience with them has actually been very positive, Jim. Having read all of the Post Op experiences in VR at the time, like everyone else, I dreaded the discomfort and was anxious about how I would feel after the AVR. When I woke up in my room on Day 2 after surgery (having been moved from the ICU during the night) I was surprised that I actually felt quite good but I was a little hesitant to move much. Shortly, a nurse came in to tell me breakfast was on the way and suggested I might feel better eating in a chair so I got out of bed. I got out of bed very gingerly expecting at any moment to feel a lot of chest pain but there wasn't any. I was bloated with fluid and stiff and very weak but there was no pain getting out of bed and moving to the chair. Breakfast was great as I watched the sun come up. Later that morning, I went for my first walk, took my first nap and then walked a little more. I was still taking pain medication every 4-6 hours through the day but I never felt that I needed it which probably just meant that the drugs were doing their job.
On day, I walked 5 times and since I didn't have a sense that my chest was painful, I stopped taking the narcotics. As it turned out, I didn't need them. My first shower that afternoon felt wonderful and by evening I noticed the food didn't seem nearly as good as it had the day before. I found that doing breathing exercises, coughing and walking were just not a problem. Altogether, I walked about half a mile and by bedtime I was very tired and my left shoulder really ached but the chest was OK. I took Tylenol before going to sleep and would have slept OK if there wasn't someone coming in to poke me every few hours just in case I should decide to become a diabetic.
Saturday morning (Day 4) that spot beneath my left shoulder blade ached all day so I kept up the Tylenol. The food seemed to be getting worse. I got a laugh from the older nurse when I asked if the food was part of a plot to get people to leave more quickly. I did some reading, walked a mile in 6 strolls and took lots of naps throughout the day. Reading still wasn't all that satisfactory because I kept going to sleep before I got very far. The MP3 player was really nice because if I went to sleep there was still music playing when I woke. The left shoulder seemed a little better by evening when my surgeon stopped by with the happy news that I could go home on Sunday. I got a chuckle from him when I asked if he was sure I was ready. He said "Your stats are good, you have little discomfort and no complications and I've heard that you are complaining about the food. Go home and recover where the food is better."
Jim, I cannot say with certainty that my experience was exclusively due to the set of Talons but when I went home on Sunday morning, the guy who had bypass surgery the same morning of my AVR (his chest was closed with wires) was still in a lot of discomfort. I have to admit that I felt somewhat guilty, as though I had not really "earned" my bear, each time I heard him getting out of bed three rooms down from me. The other fellow was 5 years younger than me, 50 lbs lighter and, yet, had a very different experience.
I went home on Sunday (Day 5) having had no difficulty coughing, sneezing, walking, etc although my left shoulder hurt for a couple of weeks longer. Seven months after my AVR I did developer costochondritis - an inflammation of the cartilage connecting the ribs to the sternum. I have wondered if this might be related to the devices but there is no way to know. Probably not, since most people who develop this condition have never even had heart surgery and no one actually knows what causes it other than suffering some type of chest injury.
You cannot prove anything based on a single experience, Jim, but the nurses who cared for me in the hospital commented several times that they could easily pick out the patients with Talons because they all used fewer drugs and were much more active. Let me know if you have questions.
Larry
Ross
Well-known member
Heck hon, they're self tapping screws, so just get out your handy dandy drill, line up the plates and drill the screws in. Probably faster they wiring.
Jim,
There are several new methods of sternum closure, as an alternative to the common wire method.
My surgeon was willing to make me a test case for Kryptonite bone cement and my recovery has been very rapid. The surgeon's comment for trying Kryptonite was as an alternative to the talons, as it seems in certain conditions that the talons may not work well for all patients and yet wire may also not be ideal for sternum closure for all patients. Talons are likely much more costly than wires I would think?
The following are a few links to the process used for me
http://www.cbc.ca/health/story/2009/11/12/breastbone-heart-surgery.html
http://www.kryptoniteusa.com/about.html
Gil
There are several new methods of sternum closure, as an alternative to the common wire method.
My surgeon was willing to make me a test case for Kryptonite bone cement and my recovery has been very rapid. The surgeon's comment for trying Kryptonite was as an alternative to the talons, as it seems in certain conditions that the talons may not work well for all patients and yet wire may also not be ideal for sternum closure for all patients. Talons are likely much more costly than wires I would think?
The following are a few links to the process used for me
http://www.cbc.ca/health/story/2009/11/12/breastbone-heart-surgery.html
http://www.kryptoniteusa.com/about.html
Gil
Thank you Gil, and especially Larry, for the very detailed response on these options for sternum closure. It's food for thought. It will be interesting to learn what my surgeon uses.
Jim
Jim
Wow, this is a great forum. I didn't even know there were other options beside wire. I know wire was used last time for Gabe and his chest is very bumpy and unveven- one side sticks out further and there are several bumps. His scar is also not the even pencil thin line like it was after his first surgery. I'm hoping that next time they can smooth things out a bit and maybe a different method of closure would help.
Becca
Becca
Any thoughts to how much more difficult it would make for people that need their chests open again? I'm guessing as the bone heals it gets pretty attatched to the plates and screws, (like they do around the wires) and it isn't like something you build that isn't alive, where the plates would just sit on the top and never fuse at all to what they are holding together.
Maybe they would be easy to cut thru to open you, but I'd imagine you'd have to remove all of the old plates so you have a clean surface to reclose the sternum after the next surgery.
Ross
Well-known member
I honestly don't know. I know Chris's foot looks like an erector set, with all the plates and screws in it, but the surgeon didn't have any problems extracting some of the hardware.
MaryG
Active member
Thanks to Jim, Larry, and also Gil for all the info about different options other than wires for closing the sternum This is a very interesting thread -- especially to those of us who haven't had surgery yet. I haven't yet heard of the plates that Jim mentioned, but have been meaning to ask Larry his opinion of the talons, now that months have passed since his surgery.
It's so helpful to have this kind of info to take to a surgeon to find out if any of these options are suitable for us.
It's so helpful to have this kind of info to take to a surgeon to find out if any of these options are suitable for us.
I wonder if the screws from that would be more noticeable in a thin person. I can see some of the knots from the wires in my chest and I can certainly feel them. Just curious.
