Tissue-disruptive forces during median sternotomy

The Heart Surgery Forum
Gil BolotinJos G Maessen

Abstract

Acute and chronic pain after median sternotomy is common and often underestimated. The mechanical retractors used for median sternotomy exert significant forces on the skeletal cage. We hypothesized that instrumented retractors could be developed to enable real-time monitoring and control of retraction forces, functions that may provide equivalent exposure with significantly reduced forces and tissue damage, and thus, less postoperative pain. We developed a novel instrumented retractor designed to enable real-time force monitoring during surgical retraction and then tested it by performing median sternotomies on 16 mature sheep. For 8 of these median sternotomies, retraction was performed to 7.5 cm at a standard "clinical pace" of 7.25 +/- 0.97 minutes without real-time monitoring of retraction forces. For the other 8 median sternotomies, we performed retraction to the same exposure using real-time visual force feedback and, consequently, a more deliberate pace of 12.05 +/- 1.73 minutes (P <.001). Retraction forces, blood pressure, and heart rate were monitored throughout the procedure. Full retraction resulted in an average force of 102.99 +/- 40.68 N at the standard clinical pace, compared to 64.68 +/- 17.60 N with force feed...Continue Reading

References

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Citations

Oct 1, 2013·The Journal of Thoracic and Cardiovascular Surgery·Philipp AignerHeinrich Schima
Mar 5, 2013·Journal of the Mechanical Behavior of Biomedical Materials·Alix C Deymier-BlackDavid C Dunand
Oct 1, 2011·Journal of Cardiothoracic and Vascular Anesthesia·Michael Mazzeffi, Yury Khelemsky
Oct 13, 2017·Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery·Silvana F MarascoRandall A Moshinsky
Apr 18, 2019·Biomedical Engineering Online·Guillaume ChanoitHugh C Crenshaw

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