Cardiothoracic Surgery Q&A: Detlev Erdmann, MD, PhD, MHSc, on Sternum Closure
Median sternotomy, in which the sternum (breast bone) is opened along a vertical line to access the heart or lungs during surgery, has long been the preferred way to open the chest cavity during cardiothoracic surgery. Though this procedure has been used for over 50 years, there have been few changes in how the sternum is closed after surgery.
Duke surgeons have helped develop a new lightweight closure device called the Sternal Talon, which offers patients another option and better results following cardiothoracic surgery. Detlev Erdmann, MD, PhD, MHSc, associate professor of surgery in the Duke Division of Plastic, Maxillofacial, and Oral Surgery, is one of the surgeons using the Sternal Talon at Duke; he explains the benefits of this new procedure.
What is the current standard for sternal closure?
Traditionally, steel wires have been used to close the sternum following median sternotomy. Wire closures can cause serious complications, including sternal splitting (dehiscence) and sternal instability (non-unions), where the sternum incision does not heal after surgery.
Steel wire closure has also known to cause superficial and deep infections, extending patient recovery time. Complications with the wires -- such as breaking or twisting -- can also cause problems, requiring additional surgery.
Older patients, those who have osteoporosis or diabetes, or those who use tobacco or steroids are more likely to experience these complications.
How is the Sternal Talon different?
The Sternal Talon is a lightweight titanium device that has recently been approved by the FDA for unrestricted use. Developed with help from Duke surgeons, the Sternum Talon requires no screws or wires and comes in different sizes to ensure that the device is fitted appropriately for each patient.
To close the sternum with the Sternal Talon, the device is inserted around the posterior sternal cortex and secured with a locking ratchet mechanism. Most procedures require three Sternal Talon devices to be placed along the incision.
Before inserting the device, the surgeon creates a track using heat and electricity (electrocautery) or a blunt dissector, which does not cut tissues, nerves, or vessels. The legs of the Sternal Talon are then inserted along the track, and the device is locked in place.
What benefits does the Sternal Talon offer to patients?
Complications resulting from wire closures can be serious and life threatening. The Sternal Talon may lead to a reduction in complications.
Are there any drawbacks to this procedure?
Data is limited, but there are no drawbacks that we know of at this point.
Who is eligible for this kind of procedure?
Any patient who experienced complications from a prior medial sternotomy or who has any other sternum defects may be eligible for sternum closure using the Sternal Talon. Patients who think they may benefit from this procedure should be evaluated by a surgeon who is familiar with the device.
For more information about the Sternal Talon, see the article abstract “An innovative approach for sternal closure” on PubMed.
Sternal Talon Slideshow
