Sternum gap after OHS

[Andrew]

Hello,

I've just had my 3rd OHS 24 days ago and I'm facing some issues with my sternum.

On the 5th day after the surgery I started to feel clicking sensation in my sternum while moving my arms. The surgeons has checked my sternum and they said it's nothing serious and supposed to be fine in a few days. They also ordered me to start to wear a chest strap to hold my sternum fixed.

Now I'm already at the rehab clinic. Here they've just made an x-ray yesterday focusing on my sternum. It shows that along the cut in the middle section the two parts are not in contact. the distance between is 5 mm. The top and the bottom of the sternum cut seems fine, the issue is only in the middle section, about 5 cm in length. Although the x-ray doesn't show any misalignment of the parts.
The doctor said I may have 50% chance of having my sternum heal properly but anyhow now I have to wait because the surgeons will not touch me in this case for at least 3 months after the surgery. If after 3 months still won't be improvements, the only possibility will be a reoperation and the surgical correction of my sternum.

I'm interested if anyone here has faced similar issues and what was the outcome of the situation.
Have you tried anything to help the healing of your sternum?

 

[ottagal]

Andrew, so sorry to hear everything you are dealing with...just dealing with a 3rd OHS is enough in itself. I can't be of any help about the sternum, but wanted to wish you all the very best and will pray that you will have a full sternal recovery.
Perhaps, other's with multiple surgeries will be able to better help you.
Thinking of you,

 

[pellicle]

Andrew

sorry to hear you're going through this. Its rare so I guess that means you're "just lucky"

Myself I have had 3 OHS (with the O meaning Open) to work on the same valve (my Aortic). I've had them spaced pretty evenly every 20 years since I was 10.

I did not have a "mobile sternum" or an improperly healed sternum on any of these occasions, but then I was strictly sternly and "in no uncertain terms" warned about my activity and failure to comply with directions could lead to such.

First let me answer a few of your questions:

On the 5th day after the surgery I started to feel clicking sensation in my sternum while moving my arms. The surgeons has checked my sternum and they said it's nothing serious and supposed to be fine in a few days. They also ordered me to start to wear a chest strap to hold my sternum fixed.

so, was it wired closed? How many wires were there (they will appear quite visibly in X-Rays (this is mine post surgery):

Given that this was discovered so soon after surgery makes me feel that its more likely a hospital error (or even a surgical one), but discovering that is of course a separate question.

Now I'm already at the rehab clinic. Here they've just made an x-ray yesterday focusing on my sternum. It shows that along the cut in the middle section the two parts are not in contact. the distance between is 5 mm. The top and the bottom of the sternum cut seems fine, the issue is only in the middle section, about 5 cm in length. Although the x-ray doesn't show any misalignment of the parts.

so the sides of the sternum are "bowed out" in the middle ?

]The doctor said I may have 50% chance of having my sternum heal properly but anyhow now I have to wait because the surgeons will not touch me in this case for at least 3 months after the surgery. If after 3 months still won't be improvements, the only possibility will be a reoperation and the surgical correction of my sternum.

Myself I'd be asking why wait so long, and do they have evidence that supports it will heal after 3 months or is it just a number they fished out after digging around in the back of their pants for a while?

I'm interested if anyone here has faced similar issues and what was the outcome of the situation.
Have you tried anything to help the healing of your sternum?

As I mentioned above I have not, so I can't speak to this, however I do know that in the case of "mobile sternums" (which means they don't knit properly and grind around) the repair is to essentially reopen, "shave each side" and then re-wire. I understand this is usually successful. Fortunately this isn't as big an operation as the original OHS was, because the heart is not involved and time to open and close therefore is shorter. You will also not need to be back on the heart lung bypass pump (which should be minimised).

There are also alternatives to follow up if their plans to rectify this don't work. So there are options yet. If you feel like a "chin wagg" about this please feel free to email me at my hotmail address (which is pellicle at hotmail dot com) and we can chat more with some discretion.

Best Wishes

 

[Andrew]

ottagal,
Thank you for your kind wishes!

pellicle,

Many thanks also for your reply.

so, was it wired closed? How many wires were there (they will appear quite visibly in X-Rays (this is mine post surgery):

Yes, my sternum was also wire closed. But I don't know exactly how many wires were used.

Given that this was discovered so soon after surgery makes me feel that its more likely a hospital error (or even a surgical one), but discovering that is of course a separate question.

I don't know. The doctors (in the surgery clinic and also in the rehab hospital) are all saying it was due to the re-re-op, since it was my third OHS with full sternotomy, cutting the sternum again where it was cut and healed already multiple times highly increases the chances of such complications I'm facing now.

so the sides of the sternum are "bowed out" in the middle ?

Yes, the x-ray shows that, but I also don't really understand how could that happen.

Myself I'd be asking why wait so long, and do they have evidence that supports it will heal after 3 months or is it just a number they fished out after digging around in the back of their pants for a while?

In the surgery clinic the surgeons said they have a policy in such cases that won't allow them to do any intervention before 3 months after surgery, unless there is a emergency situation, for example an infection around the sternum site, as there is always a chance of late sticking together the sternum sides and natural healing during these 3 months.
My doctor at the rehab hospital also told me the same, and explained further that it would be too early for me for a new surgery, since my immune system is still weak and my hemoglobin level is too low, which would put me to the risk of increased chances of infections. I need to get stronger to be prepared for a new surgery.

As I mentioned above I have not, so I can't speak to this, however I do know that in the case of "mobile sternums" (which means they don't knit properly and grind around) the repair is to essentially reopen, "shave each side" and then re-wire. I understand this is usually successful. Fortunately this isn't as big an operation as the original OHS was, because the heart is not involved and time to open and close therefore is shorter. You will also not need to be back on the heart lung bypass pump (which should be minimised).

Thanks for the info, I'm aware of these more or less. My doctor also said in case of reoperation, the surgeon may take a piece of bone from somewhere else in my body and place it in the gap in the sternum. Which also doesn't sound very nice.

 

[pellicle]

Hi

Yes, my sternum was also wire closed. But I don't know exactly how many wires were used.

a look at the xray will reveal that ... check next time you see. Also check how far between the wires are and where the bulge is in relation to the wires (I see in your bio that you too are an engineer, so perhaps you understand my analytical thinking on this)

I don't know. The doctors (in the surgery clinic and also in the rehab hospital) are all saying it was due to the re-re-op, since it was my third OHS with full sternotomy, cutting the sternum again where it was cut and healed already multiple times highly increases the chances of such complications I'm facing now.

I agree that it is a redo risk complication, but there are many I've met here who have had 3 or so and have not had such complications. There are some who have had less and lost their sternum completely

Yes, the x-ray shows that, but I also don't really understand how could that happen.

I'm not sure either, but I can speculate:

• the wires were not placed correctly (into or beside bone) and pulled through soft tissue allowing the gap to form
• you may have some osteoporosis which is making that bone (already a very thin and flexible bone btw) more likely to flex. Perhaps that explains my surgeons (well known in my region) requirement for that extra "blanket stitch" you see in my X-Ray above (photographed with my phone on a light box btw)

In the surgery clinic the surgeons said they have a policy in such cases that won't allow them to do any intervention before 3 months after surgery,

hmmm ... well I guess I can't comment on that

My doctor at the rehab hospital also told me the same, and explained further that it would be too early for me for a new surgery, since my immune system is still weak and my hemoglobin level is too low, which would put me to the risk of increased chances of infections. I need to get stronger to be prepared for a new surgery.

that sounds logical to my mind ...

My doctor also said in case of reoperation, the surgeon may take a piece of bone from somewhere else in my body and place it in the gap in the sternum. Which also doesn't sound very nice.

true, but less "not nice" than say sternum replacement surgery.

I had an infection in my 3rd surgery (you can read about it here) for which I still take antibiotics. I have undertaken many analyses to answer the question of : "Do I still have the infection or am I taking antibiotics for nothing". That question has not yet been answered (and since its likely you're stuck in hospital at the moment you can read about that here, with the view that "misery loves company" and it may make you feel less alone).

Best Wishes

 

[Andrew]

Pellicle,

a look at the xray will reveal that ... check next time you see. Also check how far between the wires are and where the bulge is in relation to the wires (I see in your bio that you too are an engineer, so perhaps you understand my analytical thinking on this)

Sure, next time I will try to check the x-ray

I'm not sure either, but I can speculate:

• the wires were not placed correctly (into or beside bone) and pulled through soft tissue allowing the gap to form
• you may have some osteoporosis which is making that bone (already a very thin and flexible bone btw) more likely to flex. Perhaps that explains my surgeons (well known in my region) requirement for that extra "blanket stitch" you see in my X-Ray above (photographed with my phone on a light box btw)

One of the nurses mentioned me another possibility, it could be caused also by bone resorption. I really don't know...

I had an infection in my 3rd surgery (you can read about it here) for which I still take antibiotics. I have undertaken many analyses to answer the question of : "Do I still have the infection or am I taking antibiotics for nothing". That question has not yet been answered (and since its likely you're stuck in hospital at the moment you can read about that here, with the view that "misery loves company" and it may make you feel less alone).

I was sorry to read your story. I wish you the best and a relaxing outcome!

By now I've passed the first 4 weeks after my surgery. I'm still wearing my chest strap but I don't feel any change with the clicking sensation.

 

[pellicle]

Hi

Pellicle,
One of the nurses mentioned me another possibility, it could be caused also by bone resorption. I really don't know...

its a valid biochemical pathway, but seems to be far to rapid (and I have no reason that I can think of that it would occur)

I was sorry to read your story. I wish you the best and a relaxing outcome!

thanks I think I'm pretty relaxed about it ... I just wouldn't mind a bit more certainty

By now I've passed the first 4 weeks after my surgery. I'm still wearing my chest strap but I don't feel any change with the clicking sensation.

that sounds positive! Check at the next xray and see if that knitting is happening. This may sound stupid but consider moving your calcium intake up a bit, milks, cheeses and stuff like that.

 

[Andrew]

that sounds positive! Check at the next xray and see if that knitting is happening. This may sound stupid but consider moving your calcium intake up a bit, milks, cheeses and stuff like that.

I will surely do check the next x-ray, I'm so curious about it. I'm already taking a branch of stuff for my sternum with the approval of my doctor: Calcium/Magnesium/Zinc tablets, D3 vitamins és K vitamin complex (K1 + K2 mk4/mk7). I hope these will help me a lot.