Essentials of Operative Cardiac Surgery by Prakash P. Punjabi

Author:Prakash P. Punjabi
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Chest Closure

Various techniques for closing the chest have been described. A secure way of closing the chest is shown (Figs. 2.2). We have used this technique extensively at our centre in more than 2,000 cases, with excellent results. At least 6 wires have to be passed. The wires should run around the sternum in the intercostal spaces except in the manubrium where it has to be passed through the bone (Fig. 2.2a). Adjacent wires on the surgeon’s side are wrapped around each other (Fig. 2.2b). The wires on the surgeon’s side are then pulled towards the assistant’s side by the assistant so that the sternum is re-approximated. Alternatively, the surgeon can also pull the wires at the assistant’s side towards himself or herself approximating the sternum. Adjacent wires on the assistant’s side are then wrapped around each other. The wrapped wires on both sides are then wrapped around each other (Fig. 2.2c). The wrapped wires are then twisted around with a twister, closing the sternum tightly and the ends of the wires are buried.

Figure 2.2(a) Sternal wires are passed around the sternum (Printed with permission © Gemma Price). (b) The sternal wires on the surgeon’s side are twisted first (Printed with permission © Gemma Price). (c) Sternal wires twisted around each other (Printed with permission © Gemma Price)

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