Available at: https://digitalcommons.calpoly.edu/theses/707
Date of Award
MS in Biomedical Engineering
Biomedical and General Engineering
Dr. Lanny Griffin
33.6% of all deaths in America are caused by cardiovascular disease. An estimated 82.6 million adults (>1 in 3) in America have some form of cardiovascular disease. There were over 400,000 bypass surgeries requiring open-heart surgery. Sternal dehiscence is associated with a morbidity rate of over 47% if mediastinitis supervenes. A rigid closure is required to avoid healing complications, and wire, plates, and bands are all used in an attempt to make a better closure. The purpose of this study it to compare multiple closures and validate a new testing method.
Polyurethane foam blocks will be used, as an alternative to cadavers, to provide homogeneous samples to test and compare multiple closure techniques. Each closure was performed by an engineer after instruction from a cardiothoracic surgeon and the SternaLock plate manufacturers. Seven different closure techniques (single suture, double suture, figure-eight suture, Robicsek weave, Sternalock Silver, Sternalock Blu, and Sternalock Wide Ladder) were compared in both lateral distraction and longitudinal shear. Statistical analysis was used to show the differences in stiffness, yield force, failure force, and yield displacement of each closure method.
Under lateral distraction, double wire closure showed the greatest stiffness followed by the Sternalock plates. The Sternalock plates had the greatest failure and yield forces, whereas the double wire performed significantly poorer. The longitudinal testing revealed that the wires provide no resistance to the shearing forces on the sternum, but the screws for plates can allow for multidirectional loading.
Overall Sternalock plates are less likely to fail in all directions compared to wired closures. Even though double wire closures displayed a higher average lateral stiffness, the high stress concentrations created by wires allowed for easy foam cutting and much lower yield force and failure force. Testing using foam blocks as sternal analogues produces highly reproducible results, with less variance than cadaveric tests.