Sternal closures??

[bbuck]

Ok, we have an appointment now to talk with the surgeon and get my AVR appointment. Looks like its suppose to be within the next two months. Anyhow, I am new to all of this and of course have some questions. What I am curious about now is the closures. Seems like alot of people have trouble with the wire that they use not holding the sternum tight. I have been looking into the options, have had a couple people message me about sternal talons. So far this looks like the best option. What I was wondering is if there has been anyone out there who have had these and can you share with me the pros and cons that you have actually found with these.
I have spoke with my surgeons office about this, they use the wire, but are willing to look into different options, so I'd like to get as much info as I can on this. Also, if anyone has any other suggestions? Sternal locks? with the screws, any problems with these? thanks for your help

Bill

 

[escargome]

Hi Bill,
You might try sending Mentu a private message. I believe his doctor utilized the sternal talons after his surgery. Mine used glue, but they sound interesting

 

[Mentu]

Bill, strange as it may seem, Tulsa is the home of Sternal Talons. They were originally the idea of a local reconstructive surgeon, Dr Archy Miller. He then worked with Dr James Spann (my heart surgeon) who helped prepare Talons for testing. The general idea is that Talons clamp the sternum closed much more securely than can sternal wires. This helps the sternum heal heal without damage. Since much of the discomfort of heart surgery centers on the grinding and flexing of the two halves of the sternum, people with Talons experience very little chest pain as my personal experience can attest.

I was in the ICU for two days so I didn't wake up clear headed until two days after surgery. I woke up in my own room just as the sun was coming up and realized that I actually felt pretty good. I felt so good that I was afraid to move until a nurse came in to ask if I was ready for breakfast. She helped shepherd my tubes and wires as I got out of bed and walked over to a chair. I found I was sore, especially, beneath my left shoulder blade but otherwise I felt OK. After breakfast and a nap, I walked around the corridors for the first time and at the end felt exhausted but not in pain. My AVR was on Tuesday. By Friday afternoon, I was able to stop taking narcotics during the day and switch to Tylenol. I did find over the next few weeks that I needed analgesics at night and in the morning but on the whole things went quite well.

With a set of Talons, your sternum is secure but you still have all of the issues everyone else faces as the chest muscles heal. Your lifting limits are the same and you experience just the same discomfort when you over use your arms. I didn't have a problem, however, sleeping in my own bed or caring for myself after I returned home on Day Five.

If you want to read more, here is the Martin website:

http://www.rapidsternalclosure.com/medical/talon.php

Take care, Bill.

Larry

 

[Greg a]

This is the Glue (Kryptonite) that has been mentioned and Luckyguy17 (Gil)'s surgeon used it http://ats.ctsnetjournals.org/cgi/content/abstract/90/3/979

 

[Jkm7]

During your conversation, be sure to request your surgeon not use staples. I'm surprised to still read now and then that some surgeons are still making zippers. Makes me shiver just thinking about it.

I had internal stitches and glue both times. A row of steristrips for about a week until it fell off in the shower as expected. I have the neatest, barely visible scar and that incision was opened twice as I had two OHS.

As to the wires, they held and healed me fine but my first surgery I had some discomfort from them mainly related to weather. I have much less of that after my second surgery.

Let us know what your surgeon thinks of the sternal talons.

 

[Lynlw]

During your conversation, be sure to request your surgeon not use staples. I'm surprised to still read now and then that some surgeons are still making zippers. Makes me shiver just thinking about it.

I had internal stitches and glue both times. A row of steristrips for about a week until it fell off in the shower as expected. I have the neatest, barely visible scar and that incision was opened twice as I had two OHS.

As to the wires, they held and healed me fine but my first surgery I had some discomfort from them mainly related to weather. I have much less of that after my second surgery.

Let us know what your surgeon thinks of the sternal talons.

As others mentioned there are things like the talons (or kryptonite glue) to hold your sternum together, altho I'm pretty sure the Kryptonite Bone Cement STILL uses wires and isnt approved in the US yet for sternums. i'm pretty sure it is still just approved for crainiums. There will be doing trials, but not recruiting yet

I'm surprised you found many people have trouble with their wires. It seems relatively rare to me. Most people seem to report little pain from the actual sternum, altho i do know of a handful of people who had to have their wirse removed

Chris did you have glue for your sterum instead of wires? or are you talking about gluing your incision together instead of sutures or staples? IF it was instead of the wires holding the bone together, thats pretty interesting I didnt know anywhere in the US was using it for that especially a few years ago.

 

[Jkm7]

As others mentioned there are things like the talons (or kryptonite glue) to hold your sternum together, altho I'm pretty sure the Kryptonite Bone Cement STILL uses wires and isnt approved in the US yet for sternums. i'm pretty sure it is still just approved for crainiums. There will be doing trials, but not recruiting yet

I'm surprised you found many people have trouble with their wires. It seems relatively rare to me. Most people seem to report little pain from the actual sternum, altho i do know of a handful of people who had to have their wirse removed

Chris did you have glue for your sterum instead of wires? or are you talking about gluing your incision together instead of sutures or staples? IF it was instead of the wires holding the bone together, thats pretty interesting I didnt know anywhere in the US was using it for that especially a few years ago.

I'm confused, Lyn.
You quote me but reference Chris.
In any case, if you meant me, I wasn't clear about the glue. The wires held my sternum together and internal stitches with glue on surface skin closed my incisions.

 

[escargome]

As others mentioned there are things like the talons (or kryptonite glue) to hold your sternum together, altho I'm pretty sure the Kryptonite Bone Cement STILL uses wires and isnt approved in the US yet for sternums. i'm pretty sure it is still just approved for crainiums. There will be doing trials, but not recruiting yet

I'm surprised you found many people have trouble with their wires. It seems relatively rare to me. Most people seem to report little pain from the actual sternum, altho i do know of a handful of people who had to have their wirse removed

Chris did you have glue for your sterum instead of wires? or are you talking about gluing your incision together instead of sutures or staples? IF it was instead of the wires holding the bone together, thats pretty interesting I didnt know anywhere in the US was using it for that especially a few years ago.

Sorry Lyn,
I have wires, but had my incision glued. I regret the mis-information. But my wires are holding steady and even though I had a SEVERE bout of coughing about 6 days post-surgery they held strong along with the glue (I thought sure I had ripped everything out). Again sorry for the misinformation.

 

[bbuck]

I have read I believe on this site that many have had problems with the wires, having to have them re tightened, or breaking, or their sternum halves rubbing together because it doesnt hold them tight. I have a very physical job, and was looking for something more stable, not so much to get me back to work quicker, but once I am back, something that will hold strong

 

[kfay]

Bbuck, You need to think of whatever material is used to hold your sternum together as a cast. Once the sternum bone heals, like any other bone in your body, you no longer need the cast, so the wires have done their job and really are no longer needed. They are typically left in place unless they are causing issues (which for the majority of people who have them they don't) because they have to do more surgery to get them out, versus a cast that can be cut off. So, I think the general consensus is it takes about 12 weeks before your sternum is pretty much healed and assuming your surgeon has released you back to work, you should be able to do it without worrying about what was used to close you up letting lose.

As for people whose sternums don't heal properly and rub together, I think that is usually a whole other issue that has nothing to do with what you were closed with.


Kim

 

[Jkm7]

Most important is to strictly follow surgeon's instructions as to weight lifting restrictions. They really mean it and if not followed, we can risk interfering with a good sternal healing. It's worth it for the weeks we can't lift to have our sternum heal well first time through...... for the rest of our lives, hopefully.

 

[Lynlw]

I'm confused, Lyn.
You quote me but reference Chris.
In any case, if you meant me, I wasn't clear about the glue. The wires held my sternum together and internal stitches with glue on surface skin closed my incisions.

sorry I actually responded to 3 different people, you and the glue for incisions and not staples 9i agree ask about that ) , bbuck about being surprised he found so many who had problems with wires
and then chris about glue for sternum.. i just only now how to copy 1 person"s post

 

[Lynlw]

Bbuck, You need to think of whatever material is used to hold your sternum together as a cast. Once the sternum bone heals, like any other bone in your body, you no longer need the cast, so the wires have done their job and really are no longer needed. They are typically left in place unless they are causing issues (which for the majority of people who have them they don't) because they have to do more surgery to get them out, versus a cast that can be cut off. So, I think the general consensus is about 12 weeks before your sternum is pretty much healed and assuming your surgeon has released you back to work, you should be able to do it without worrying about what was used to close you up letting lose.

As for people whose sternums don't heal properly and rub together, I think that is usually a whole other issue that has nothing to do with what you were closed with.


Kim

I agree and think you gave a great description

 

[mainframe]

While I didn't have problems with the wires holding sternum in place for either with either surgery, I did have problems with the wires after my second surgery. After 4 or 5 months, I my incision opened up a bit and started to drain a bit of fluid. The doc's thought I was having a problem with 1 of the wires, which was removed by a general surgeron. The problem persisted for another few months and my cardiologist was concerned about a sternal infection spreading to my pacemaker and/or mechanical valve, so was refered to a thoracic surgeon to have all the wires removed and clean up any infected tissue. Seems my body was rejecting the wires after the second surgery. I ended up having another surgery performed by both the thoracic surgeon and a plastic surgeron to remove all the wires, clean up any infected tissue and had a muscle flap revision and close. (I feel fortunate the muscle flap revision just moved my pecs inward a bit to ensure a blood supply to the skin rather than the pec severed from the shoulder.)

I'm sure this isn't a problem for most folks, it just seems like I'm lucky.

 

[Greg a]

As others mentioned there are things like the talons (or kryptonite glue) to hold your sternum together, altho I'm pretty sure the Kryptonite Bone Cement STILL uses wires and isnt approved in the US yet for sternums. i'm pretty sure it is still just approved for crainiums. There will be doing trials, but not recruiting yet

I'm surprised you found many people have trouble with their wires. It seems relatively rare to me. Most people seem to report little pain from the actual sternum, altho i do know of a handful of people who had to have their wirse removed

Chris did you have glue for your sterum instead of wires? or are you talking about gluing your incision together instead of sutures or staples? IF it was instead of the wires holding the bone together, thats pretty interesting I didnt know anywhere in the US was using it for that especially a few years ago.

I am pretty sure that Gil's sternum was done with just the glue

 

[normofthenorth]

+1 to the gist of all these comments. I had the conventional stainless-steel wires on a full sternotomy, and I had less pain and way fewer narcotics than Larry did with the Talons -- not that a tiny "statistical sample" like ours proves anything. As long as we avoid lifting heavy things or otherwise disturbing the healing sternum, most of us end up healing just fine. I found the promise of the Kryptonite glue (instead of SS wires) attractive, but my impressive surgeon wasn't as attracted as I was -- and it's not approved for general (non-study) patients here in Canada yet, either.

The only people I've heard of here who've had serious problems with the SS wires are two who actually tore theirs, both in violent fits of vomiting, IIRC. Hurling seems to be even more violent than sneezing, which was definitely violent enough for ME!

 

[Luckyguy17]

Hi folks,

Thanks to Greg for the heads up on this thread, as I am referred to and do have a few details to add.

I am one of the folks who had his sternum re-attached with Kryptonite glue , surgery done in May 2009. I know no one else, including "on this forum" to have had glue used for sternum closure. My surgery was also the 1st time kryptonite was used for cardiac surgery in Montreal. I inquired about the glue for sternum closure to the surgeon while in our pre-op meeting.

My surgeon was very aware of the glue and he was curious to try the glue as an alternative for some patients, to the use of sternum talons. Therefore at my request for the glue and with no heavy coaxing, the surgeon suggested that he would get pre op training from the manufacturer for using the glue. The surgeon stated in the same meeting, that he did not believe that i needed either talons or glue, wire used in most cases, but he was curious to try the glue and my request made it oK to do so. He did express that in some surgical cases sternum closure was an issue and also in some rare cases the talons were not ideal or easy, so he was willing to try the glue with me for his discovery and I was happy to be the trial case for the glue.....a win/win.

I am really pleased with how the glue worked for me, but I cannot say what it would have been with wires or sternum talons, as have only had one cardiac surgery and have no other basis for surgery recovery other than my younger buddies from the valvereplacement.org graduating class of May 2009. My recovery from surgery was quite exceptional and I had no need for any pain meds from 3 days after surgery. Was quite active 8 days post op and walking good distances Any discomfort i experienced was primarily from tissue healing and primarily with rising from a prone position to sitting position, sneeze or cough was no fun...but all was very bearable & daily improvement.

To clarify, sternum was glued with Kryptonite and am not aware of any wire used in my case. Incision was closed with staples (52 as i recall for a 10" incision) and I have very little scar showing from the incision, so it was all good for me, staples not an issue or heavy scarring.

There was never any question in my case of any health board/FAA type requirement for approval of glue use for sternum closure. To my knowledge the glue has been used in the human body for quite some time now, it is only relatively new to cardiac surgeons, (2-3 years), whereas it seems general surgeons have been gluing bones for quite some time with Kryptonite....so why would this be an issue? I do find this fear quite confusing as it is what I had done my research on a full 2 years ago.

Suggest that it does not hurt to ask the surgeon about kryptonite, but truth is that (at least in Canada), the surgeon will make a judgment call on the methods he and his team use and as a patient, we can only trust them to do what they think is best....in my case i had requested a biological aortic bovine valve for my AVR and the surgeon had agreed to it. Yet I ended up with a porcine valve and can only assume that the surgeon made a judgment call during the surgery, either it was best fit or? and for which i have never received clarification.

My porcine valve is working great and my recovery went better that i expected so am grateful for surgeons choices and methods, as had no complications and a complete recovery.


Gil

 

[tobagotwo]

I had no problems or slippage with the wires either time. Nor extra pain. Please note the word "can" in the advertising for the talons. It's not a statement that they do reduce sternal pain, just a suggestion that they "can." Not a bad product, and I wouldn't mind having them if the surgeon used them, but they are mostly intended as a speed boon to the surgeon, like the tissue glue (a variant of Superglue).

As far as the incision itself, I had staples the first time, and glue the second. The staples do a better job of holding things in place while they heal. Like a butterfly on a pin, what they hold doesn't move. I prefer them for final results.

The glue lets the tissues stretch outward during healing. Where your, uh, "chest" used to "stare straight ahead," with glue, it may wind up a bit, well, uh, "wall-eyed." If you're quite thin, that probably wouldn't present as much of an issue. Otherwise, it may be a consideration...

Best wishes,

 

[Bryan B]

I have had two surgeries (so far). The first time i had wires and they used glue for the incision. I had constant pain with the wires even though they could not find a wire that had come loose or broken off. The pain persisted and just over 6 months after surgery I had them all removed and the pain was immediately gone (and incision was re-glued).

When it was time for my second surgery I told my surgeon about the problems I had with the wires after my first surgery and asked about using the talons or the kryptonite glue. He said the glue was not approved yet and he said he has always used wires with good results and talons were much more expensive. So wires it was and although I have had some issues with sternum pain it hasn't reached the point I would want to have them removed.

As for the incision I asked him if he used glue or staples and he said staples. I asked him if he could use glue and he said no I have always used staples with good results and less issues post-op with the incision. I actually found the staples comforting in some ways and time and chest hair has made the difference in how the scar looks negligible.

So to recap I went in wanting talons for the sternum and glue for the incision and came out with wires and staples LOLOL! In the long run I think either way is fine as long as the heart and new valve are getting along.

 

[Luckyguy17]

To clarify, i had Kryptonite glue and wires for sternum closure, (chest xray 6 years later showed the wires). The Kryptonite Glue made bone rigidity immediate it seems, soft tissue healing in weeks. Skin closure was staples, removed about 2 weeks later.