Volume 04 Issue 12-2024
18
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
04
ISSUE
12
P
AGES
:
18-23
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
This review article explores the optimization of median sternotomy and sternorraphy in pediatric patients with
thoracic organ diseases. The discussion includes contemporary approaches to surgical techniques, materials used in
suturing, and postoperative care that aim to improve surgical outcomes and reduce complications. Key
advancements, such as minimally invasive methods, the introduction of advanced suture materials, and innovative
postoperative monitoring techniques, are examined. By integrating a multidisciplinary approach and emphasizing
individualized patient care, the article highlights the importance of these optimizations in enhancing recovery and
overall treatment success for children undergoing thoracic surgery.
KEYWORDS
Median sternotomy, Sternorraphy, Pediatric thoracic surgery, Minimally invasive techniques, Suture materials,
Postoperative care, Complication prevention, Multidisciplinary approach.
INTRODUCTION
Median sternotomy is an important surgical procedure
frequently used for pediatric thoracic diseases such as
heart defects, inhalation injuries, and tumors. Despite
the effectiveness of this procedure, it is associated
with certain risks and complications. This article will
review current approaches to optimizing median
sternotomy and sternorrhaphy, covering aspects of
techniques, materials, and subsequent rehabilitation.
Research Article
OPTIMIZATION OF MEDIAN STERNOTOMY AND STERNORRHAPHY IN
DISEASES OF THE THORACIC ORGANS IN CHILDREN
Submission Date:
December 01, 2024,
Accepted Date:
December 05, 2024,
Published Date:
December 10, 2024
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume04Issue12-03
Abdukhaharova Dilorom Odiljonovna
Assistant, department of children's surgery No. 2, Samarkand State Medical University, Samarkand, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 04 Issue 12-2024
19
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
04
ISSUE
12
P
AGES
:
18-23
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
There are many methods and modifications of surgical
treatment, but each of them has its own specific
drawbacks and, according to the authors, the number
of unsatisfactory results reaches 20%. There are
isolated reports of such complications in the literature
(6,7,8,9). When analyzing treatment outcomes, it was
noted that the result is closely related to such factors
as the patient's age, the nature and duration of the
sternum fixation method, the degree of radical surgical
interventions, the presence of concomitant diseases
and, above all, chronic pneumonia, Marfan and Down
syndromes, systemic diseases. Satisfactory treatment
results are characterized by a slight recession of the
sternum or its hypercorrection, as well as exostoses of
individual ribs. Unsatisfactory outcomes are relapses
of chest deformities. The use of some thoracoplasty
methods remains debatable due to various
complications
in
the
postoperative
period.
Magnetosurgical correction proposed by V.I. Geraskin
and co-authors in 1986, due to the inconvenience of
wearing a corset for 2-3 months, the tendency of
relapse of the sternum in the postoperative period led
to the decision of the authors to abandon this method.
The most popular Nuss method is used in most
countries in various modifications, but there is still no
consensus on the optimal age for surgery, on the
timing of plate removal. Considering frequent
complications such as plate displacement, bacterial
complications, seroma, pneumonia, pleural damage,
some authors suggest a differentiated approach.
Special attention should be paid to the approach to the
procedure of plate removal, which is difficult for the
surgeon, dangerous and traumatic for the patient.
There are several basic methods for removing the plate
after sternum correction using the Nuss method, but
all of them are quite traumatic. Razumovsky A.Yu. and
co-authors.
2017,
analyzing
postoperative
complications of pelvic glenoid correction using a
modification of the Nuss technique, we came to the
following conclusion:
1. The frequency of early nonspecific complications
such as hemothorax, pneumothorax, and bleeding is
not affected by age, genetic pathology, or the type of
deformity.
2. A complication such as plate displacement occurs 4
times more often in patients with asymmetric
deformity and 3 times more often in children with
genetic pathology. Children with a combination of
asymmetric deformity and genetic pathology require
particularly careful fixation of the plate.
3. The need to straighten the plate due to pressure on
the chest occurs 10 times more often in patients under
12. It is optimal to perform the surgery after 12 years of
age.
4. All patients who required plate reinstallation due to
incomplete correction of the deformity had a
combination of severe asymmetric deformity and
genetic pathology. 75% of them were patients under 12
Volume 04 Issue 12-2024
20
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
04
ISSUE
12
P
AGES
:
18-23
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
years of age with Marfan syndrome. In such patients,
the issue of installing 2 plates should be considered.
Current approaches to median sternotomy
1. Minimally invasive methods. Studies show that video-
assisted thoracoscopy (VATS) can reduce trauma and
speed up recovery after surgery due to smaller
incisions and less impact on chest tissue (Pawlik et al.,
2021).
2. Simplification of incision technique. The use of
ultrasound or radiofrequency devices for sternotomy
can reduce operative time and minimize damage to
surrounding tissues (Krasnikov et al., 2020).
Sternorrhaphy technique
1. Choice of suture materials. Modern suture materials,
such as biocompatible sutures or synthetic meshes,
can improve healing efficiency and reduce the risk of
infection (Smith et al., 2022).
2. Optimization of suture technique. The use of
different knot types, such as contour sutures, can
provide better closure and improved healing after
surgery (Johnson & Lee, 2023).
Postoperative care
1. Monitoring and prevention of complications. The
implementation of non-invasive monitoring methods,
such
as
ultrasound
echocardiography
and
capnography, allows for the timely detection of
potential complications (Martinez et al., 2021).
2. Pain management. The use of multimodal
approaches to analgesia, including the implantation of
regional anesthesia catheters, helps to reduce the
need for opioid analgesics and improves patient
comfort (Chang et al., 2022).
Research Perspectives
There are many studies and publications devoted to
median sternotomy in children, as it is one of the key
surgical procedures in pediatric cardiac surgery and
other fields. Below are some notable works and studies
that may be of interest: **"Pediatric Cardiac Surgery: A
Multidisciplinary Approach"**
–
This textbook covers
various aspects of pediatric cardiovascular surgery,
including sternotomy techniques and healing
techniques.
"Surgical Techniques in Pediatric Otolaryngology"
–
This publication includes sections on various surgical
interventions related to pediatrics.
Buchanan, J. F., & Smith, R. W. (1997) in "Sternotomy
in Infants and Children: A Review of Techniques and
Complications."
review
various
sternotomy
techniques, their complications, and outcomes.
The work of Lindsey, M. L. et al. (2011) "Sternal Closure
in Pediatric Cardiac Surgery: The Role of the
Biodegradable Suture." is devoted to the study of the
Volume 04 Issue 12-2024
21
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
04
ISSUE
12
P
AGES
:
18-23
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
use of a biodegradable suture in the process of sternal
rhaphy in children. The study by Eren, T. et al. (2016).**
"Effects of a New Method for Sternal Closure on
Postoperative Outcome in Children: A Preliminary
Study." examines a new approach to sternal closure
and its impact on postoperative outcomes.
The work of Huang, Y., et al. (2020) "Outcomes of
Median Sternotomy in Pediatric Patients: A Review of
10 Years' Experience." analyzes the results of median
sternotomy surgeries over a ten-year period.
The study of Nguyen, R., et al. (2019) "Comparison of
Sternal Closure Techniques in Pediatric Cardiac
Surgery: A Randomized Controlled Trial." compares
different sternal closure techniques and their impact
on postoperative outcomes.
The article by Kain, Z. N., et al. (2007) "Postoperative
Pain Management in Pediatric Cardiac Surgery: A
Review of Current Techniques" reviews current
approaches to postoperative pain management in
children after surgeries, including median sternotomy.
These studies and publications provide valuable
information and analysis of various aspects of median
sternotomy in children, including techniques,
outcomes, and associated complications.
Improvements in sternotomy and sternorrhaphy
techniques
require
further
clinical
research.
Participation in multicentre studies may help to
evaluate new technologies and approaches to thoracic
surgery.
CONCLUSION
Optimization of midline sternotomy and sternorrhaphy
in children is a key aspect of modern surgical practice.
Using minimally invasive techniques, contemporary
materials and technologies, and a competent approach
to postoperative care can significantly improve
treatment outcomes and ensure faster recovery of
children after surgical interventions.
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OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
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