[HSF] sternal bleeding- Mediastinitis

[Nasser F. Abou'Seada]

I was wondering what would be the experience of the members in cases of
re-sternotomy in cases of deep mediastinitis, where the sternal edges are
engraved till bleeding, the sternal edges are left to bleed all the time,...
and no bovie Bar-B-Q. 
One would be cautious in using surgical buttresses .... !! ... and any
foreign poly-filamentous sutures ...  

NFA

> From: Rwmfglycar at aol.com
> In a message dated 12/10/2006 5:39:10 P.M. Eastern Standard Time, ani
> anywanyu wrote:
> 
> I  would be keen to know from experienced surgeons if they have seen  this
> >problem
> >>  before and how many times in their  career.
> Yes I did see severe bony bleeding from the sternum. I do not have
numbers.
> It happened in cases in which the wires were passed through the bone. My
> remedy  was to make four long tight rolls of the gauze form of hemostatic
cellulose
> and  pass the needle through a roll on the outer surface and a roll on the
> inner  surface of each side of the divided sternum. When the wires were
> tightened  hemostatic material was tightly compressed against inner and
outer table
> holes  on each side. I do not remember this not working (I take no
responsibilty
> for  the workings of surgical memory) but I definitely never had to remove
a
> sternum for bleeding. I must say that my method of using the wires evolved
> to using criss-cross or figure of eight wires  passing them  around the
sternum
> hugging the bone all the way.Each figure of eight involved  two
intercostal
> levels. Since more strands of wire were holding the sternum  together and
the
> wires were exerting diagonal force on the outside of  the bone they were
less
> likely to erode the bone. Obviously a sloppy placement  of the suture that
did
> not hug the bone could bag a mammary or intercostal  artery.
> Probably the best sternal closure I used was provided by Parham's bands
> passed around the sternum. They were malleable stainless bands used to
stabilise
> spiral fractures of the humerus. They were wide and did not erode through
bone.
>   They took longer to use.
> Bob