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Sternal wires are used to hold the sternum together after a procedure where it is cracked to access the chest cavity. This is necessary in traditional open heart surgical procedures where the doctor needs to be able to clearly visualize the surgical site. After the procedure, the patient will be monitored.
The bones of the rib cage provide a strong but elastic container for the heart and lungs, which need to be able to move while they function while still being protected from impact. In some types of surgery, the sternum is cut apart to allow the surgeon to open the rib cage. After surgery, the sternum needs to be firmly wired back together to hold it while the patient heals. Sternal wires can be looped or wound around the sternum to stabilize the bone and prevent spontaneous separation of the wound under strain.
This separation, called dehiscence, is a particular concern with sternal injuries because the bone is subject to high stress from both within and without. While the heartbeat may appear relatively subtle from the outside of the chest, it actually moves around quite energetically, and the constant inflation and deflation of the lungs adds strain. Pressures from the outside can include compression when patients bend, as well as impact strain from falling or being hit in the chest.
After placing sternal wires to hold the bone together, the surgeon can use glue or specialized bandages to close the incision. Stitches or staples may be used in some cases if the doctor prefers them, although they can make the scarring from the surgery much worse. During the process of healing, the patient’s sternal wires can be checked with x-rays to make sure they are not migrating, damaging the bone, or separating, indicating that the sternum may be pulling apart.
Sternum wires are not routinely removed after the healing is complete. For most patients, they will remain in place. If the doctor decides it to be necessary, the wires may be removed with a second operation. This is often done if chronic pain and soreness occurs due to the wires.
A common concern among individuals with sternum wires is whether the wires will set off metal detectors. Sternum wires do not generally set off metal detectors and those who have them can travel through airports and other locations with security scanners without concern. It might be beneficial to mention the issue to the security personnel before stepping through the scan or carry a note from a doctor about the presence of sternal wires.
Precautions Care for Sternum Wires After Open Heart Surgery
An open heart surgery is where a surgeon cuts your chest to operate on your heart's valves, muscles, or arteries. Open heart surgery is often referred to as traditional heart surgery. Nonetheless, today, many procedures are only performed with tiny incisions. Still, the term applies to modern small-incision heart surgeries.
The surgeon separates your breastbone sternum during open-heart surgery to access your heart. After the surgery, your sternum is repaired and aligned into the proper position. Then you receive a list of to-do things and other actions to avoid, known as sternal precautions. The precautions protect you and reduce the risk of infection in your sternal incision.
Sternal precautions depend on your surgeon, the rehabilitation facility, and your body. Nonetheless, the basic instructions include:
- Don't stretch both your arms overhead
- Don't stretch both arms to the side
- Don't use your hands to push or pull items
- Don't drive or bend at the waist
If you undergo physical therapy, your therapist will change the precautions. Follow the surgeon's guidelines because your experience is not the same as others.
The good part is you don't have to wait until your breast bone heals to resume normal activities. Since you are under the guidance of a medical practitioner, don't be afraid to ask questions about what's expected of you.
Possible Risks and Solutions for Sternal Wires
Your surgeon uses several twists of wires in sternal closures. Yet, in rare cases, the sternal breaks under physiologic loads such as cyclic respiration and coughing. The breaks or cracks happen when the inducer-derived strength exceeds the UTS of the wire. Below are potential complications that arise with the use of sternal wires.
Wound Infection Without Instability
Various factors can interfere with the ability of your wound to heal completely and result in secondary injuries. For example, diabetic patients develop impaired wounds due to frequent tension. Also, if you have extra-large breasts, you will likely get distention of your skin layer.
If your sternum faces continuous mobility of the edges, the ideal corrective option is complete wound revision. Then, your doctors will clean and rinse your wounds to end the infection. If the procedure cannot eradicate the infection, an alternative is antibiotic tube irrigation that stabilizes your sternum.
Wound Infection With Instability
The worst-case scenario is when you simultaneously get a sternal wound infection and sternal instability. The frequent motion of your sternal edges causes secondary infection and inflammation. Finally, when the wires shatter your bones, your sternum undergoes complete destruction and extensive bone loss.
A surgical procedure eliminates any infection. First, your surgeons clean your wound to remove debris and clean bacteria. Then, if you are lucky, your condition can heal with infected wires. Your doctors will remove the wires when you recover.
Non-infected Sternal Instability
Your breastbone sternum could become less flexible due to movement other than an infection. For example, extreme coughs cause you to move around with forces that can cause the wires to tear through the sternal bone. As a result, your sternal wires become unstable and predisposes you to chronic pain.
A surgical procedure restores the strength if your only problem is loose wires. If the wires tear off your bones, but the edges remain intact, you will get wiring. Finally, if the wire easily tears your bones, you get a non-absorbable braided suture around your bones.
Relationship Between Sternal Wire and Chronic Post Sternotomy Pain
Research shows that removing sternal wires manages chronic post-operational pain after heart surgery. Chronic post-operational pain occurs in the surgery's location and lasts for longer than the recovery period. Untreated pain causes severe disorders such as behavioral change, hypertension, and pulmonary complications.
Sternal wires-related causes of chest pains are associated with nerve injuries and musculoskeletal factors. Intercostal neuralgia and sternal wires cause a scar at the operation site and cause chronic post sternotomy pain. Musculoskeletal factors that cause extreme post-operational pain occurs when the sternal wire:
- Breaks or fractures
- Migrates towards the skin
- Becomes unstable of fails to heal completely
In rare cases, your body could develop a hypersensitive reaction against the sternal wire. Also, your psychology could affect your perception of pain and cause extreme sensitivity and exaggerated response to mild discomfort. So, anytime you feel minor pain, your body will have a severe reaction to the pain.
Sternal wires are an essential component of protection after you undergo heart surgeries. Whereas you may face painful episodes, the situation is manageable with proper medical care. Also, with the many success stories and improved techniques, you have nothing to worry about if you are a victim of heart surgery.