Rigid fixation vs. sternal wires

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Asystole

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Those of you undergoing OHS please discuss with your surgeon which method they will use to close your sternotomy.

I had my first OHS in 2003 and my sternotomy was closed with sternal wires. I had the typical post-op pain and had to occasionally use opioid pain meds. I hate sleeping on my back and it took a couple of months before I could tolerate sleeping on my side again.

I had my second OHS in 2017. The same surgeon performed the surgery and I joked with him before surgery that he was going to "safety wire me back up again". The sternal wire is very similar to the safety wire used to secure aircraft bolts, screws and other components. He said that was a good segue into what he was planning for sternal fixation. He said he recently started using the SternaLock Blu rigid fixation system and that I was an ideal candidate. He explained how it worked and said that I should have a quicker and less painful recovery. He was correct. My nurses were amazed that I did not need any opioid pain meds post op and once home was sleeping on my side less than two weeks post-op.

I strongly endorse a rigid fixation system over the traditional sternal wires. Please ask your surgeon to discuss the pros/cons with you.

https://www.zimmerbiomet.com/medical-professionals/thoracic/sternalock-blu-primary-closure-system.html
 

pellicle

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I agree entirely about the discussion of pros and cons. However there are a number of issues which must be considered, starting with we have only a small amount of experience across a small cross section of age groups.

I've had 3 OHS with regular sternal wires and while there was some discomfort during healing to me the outcome should be the many decades (I have had OHS at 10, 28 and 48) of healthy activity after the few months of discomfort.

Sternal wires are (relatively) routinely removed, but to my knowledge these clamps are not.

I can also say that (from experience) infections where wires are concerned are a simple matter to remove with no significant risks, I'm unsure about the sternal talons and other brands.

Myself I am a modernisationist, believing that solutions to problems are had by moving into technology. However picking winners of which technology, is best left to the book makers (who are the only ones making money out of gambling).

Here is my "wiring harness" post surgery 3 ... you'll see remnants of older wires which were unable to be removed, one only wonders what redo surgery would be like with Talons



you can also see the disc of my mech valve there too.

The top two wires were removed as part of my "fix the infection" after surgery 3

With respect to that this is a photo I took on "attempt 2" of that "fix the infection" during a dressing change. Yes I took that picture myself with my phone.



NOTE that I am not saying "the product that you linked to" (and seem to be shilling) is bad or even that its not "the answer" ... just that level evidence based knowledge is the best thing to get.
 
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pellicle

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Studies show that rigid fixation is overall superior to sternal wires.
thats good, I would have appreciated it (personally, save me researching it) if you'd placed some of them here (rather than a link to what appears to be a company) and if those studies covered any of the areas of interest I raised.

Also, you should look up the word "seem" in the dictionary ... you seem unfamiliar with its meaning.

Personally I don't link directly to products without some disclaimer.

Best Wishes
 

Gordo60

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I’ve had surgery for smashed jaw / cheekbones due to a fall. The titanium plates / screws used to hold the bones in place look similar to smaller version of sternalock. I had a couple removed as I didn’t like the feel of them under the skin. Quick and easy short operation under general. Titanium plates have been used for a very long time now for all sorts of internal bone fixations. They rarely cause any problem with a huge number of people worldwide having been fitted with titanium plates for one reason or another.

I’ve got Sternalock on my list of questions for the surgeon when the times comes.
 

pellicle

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...I had a couple removed as I didn’t like the feel of them under the skin. Quick and easy short operation under general...
I’ve got Sternalock on my list of questions for the surgeon when the times comes.
good to know Gordo ... thanks

was the incision large? Mine for the wire removal (well the one in 1993) was like insignificant and IIRC it wasn't GA but twilight and I was home next AM
 

Agian

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I asked about talons and my surgeon said they were bulky. I'm just curious to know whether they're annoying in any way. Just out of interest. I had the wires.
 

Keithl

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I wish I knew there were options before my surgery as the wires to me while tried and proven seem kludgy, I would prefer a rigid system that would promote faster healing and recovery.
 

Asystole

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I asked about talons and my surgeon said they were bulky. I'm just curious to know whether they're annoying in any way. Just out of interest. I had the wires.
Everyone's different, but in my case I cannot feel them at all. I have the SternaLock Blu.
 
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Mentu

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My surgery was performed at Oklahoma Heart Institu
Ten years ago Sternal Talons were used to close my chest during my first valve replacement. My surgeon, Dr James Span, was one of the two inventors along with Dr Archy Miller. From the time I first got out of bed, I had no chest pain. I walked easily, took showers and even did a little laundry after getting home. They helped make recovery go smoothly and have been no trouble since. I've never been able to feel any of the 4 Talons. That said, I did encounter other chest issues. My sternum was stable which led me to be less aware of my recovering chest muscles...until I made a pot of soup. The repetitive motion of cutting up the veggies left my muscles sore for a couple of days. Aside from that, my Talons worked well and set me up for a good recovery experience.

Larry in Tulsa
rhight02@gmail.com
 

pellicle

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I forgot to mention that following my surgery, the nurses said they knew who had Talons because those patients made less noise, used less pain meds and were more active than patients with wires.
informative ...
Like all things medical I reserve my own judgement for the "system overall" until significant data is found across a variety of patients. I know of a few people who being younger and active needed the wires out because of their activity (Tae Kwon Do) and the constant flexing of the sternum in rolls and such. I did note Gordons comments about his jaw component removals but equally know that propionibacteria infections of implants around the sebaceous areas (chest and back) can cause problems which emerge in months to years after surgery, hopefully the talons removal is not as risky as removal of sternal wires.
 

Gordo60

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good to know Gordo ... thanks

was the incision large? Mine for the wire removal (well the one in 1993) was like insignificant and IIRC it wasn't GA but twilight and I was home next AM
Small incisions from memory. Skin can stretch well. It’s all done inside the mouth.

I’d had an earlier jaw surgery years prior to the fall. I also had those titanium plates removed. Rather amusing in what should have been a very short operation ended up taking near 90 minutes. During the original surgery an odd headed screw was included in the mix and not noted in the records. So when they went to remove the plate screws they didn’t have the correct screwdriver for the odd headed one. So it took them near an hour to locate the right screwdriver hence I had to remain under during this time.
 
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pellicle

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Shin can stretch well.
growing up around a farming area (uncle had sheep and cattle) I'm aware of how much skin can stretch (skinned a few rabbits in my time too).

... It’s all done inside the mouth.
ahh ... that's different


... During the original surgery an odd headed screw was included in the mix and not noted in the records. So when they went to remove the plate screws they didn’t have the correct screwdriver for the odd headed one. So it took them near an hour to locate the right screwdriver hence I had to remain under during this time.
LOL
 

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