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Wire holder: A new adjunct for sternal closure
Wire holder: A new adjunct for sternal closure A new 5 inch clamp with a tungsten carbide insert used for holding the sternal closure wires on an end-to-end fashion is described. This clamp provides a much better grip and longer wear than stainless steel owing to the tungsten carbide insert. The length of the clamp allows the surgeon a firm grip on the wire, and the wire can be easily twisted. Also, the small size of the clamp avoids the crowding which occurs with the regular Kocher clamps at the operating table.
Pedro A. Rubio, M.D., Houston,
Texas
From the Department of Surgery, Medical Center Del Oro Hospital, Houston, Texas 77054. Received for publication Aug. 23, 1976. Accepted for publication Sept. 24, 1976. Address for reprints: Pedro A. Rubio, M.D., Medical Center Del Oro, 7800 Fannin, Suite 201, Houston, Texas 77054.
O e v e r a l methods of sternal reapproximation, for which a wide variety of materials are used, have been described. However, wire seems to be the most reliable and the most widely used material for this purpose. Plastic bands 1 * 2 and heavy Dacron 3 have been utilized,
Fig. 1. Close-up view demonstrating tungsten carbide insert and wire position.
Fig. 2. Total length of clamp is 5 inches, providing excellent grip. 449
4 50
Rubio
The Journal of Thoracic and Cardiovascular Surgery
Fig. 3. Two clamps as utilized during operation. Note small piece of wire required and easy maneuverability. as has wire reapproximation of the sternum, which is indeed a strenuous task. It is important for the surgeon to be comfortable and to have an adequate grip on the clamp he is utilizing. For a long time, my colleagues and I have used Kocher clamps, in which the wire is placed at a right angle. This system allows a good grip on the clamp. However, the clamp crowds the operating field and causes problems with glove tearing because of its length and the portions of the wire that stick out, a problem familiar to all cardiac surgeons. We have also utilized a modification of a Kocher clamp.4 The inconvenience of this system, however, is that the grip obtained by this type of modified clamp is not strong enough and allows motion of the wire at the tip of the clamp. In order to help alleviate the problems which we encountered on each case, Codman & Shurtleff, Inc., designed a new instrument: a 5 inch clamp that has a tungsten carbide insert which provides a much better grip and longer wear than stainless steel.* *Codman & Shurtleff, Inc., Randolph, Mass.
Fig. 1 shows the manner in which this clamp holds the wire. We have utilized this clamp in all our median sternotomy cases in the past 6 months and it has proved to be a very useful adjunct to the wire closure of the sternum. Fig. 2 shows the total length of the clamp with the wire in place, and Fig. 3 shows two clamps on both sides of the wire. The tungsten carbide insert is almost as strong as diamond and allows the surgeon to pull as hard as necessary to mobilize the wire adequately before it is twisted. REFERENCES 1 Sanfelippo, P. M., and Danielson, G. K.: Nylon Bands for Closure of Median Sternotomy Incisions: An Unacceptable Method, Ann. Thorac. Surg. 13: 404, 1972. 2 Timmes, J. J., Wolvek, S., Fernando, M., et al.: A New Method of Sternal Approximation, Ann. Thorac. Surg. 15: 544, 1973. 3 Okies, J. E., and Phillips, S. J.: Correspondence, Ann. Thorac. Surg. 17: 423, 1974. 4 Korompai, F. L., Hayward, R. H., and Guinn, G. A.: Clamp for Wire Closure of Sternum, Ann. Thorac. Surg. 21: 249, 1976.
Pedro A. Rubio, M.D., Houston,
Texas
From the Department of Surgery, Medical Center Del Oro Hospital, Houston, Texas 77054. Received for publication Aug. 23, 1976. Accepted for publication Sept. 24, 1976. Address for reprints: Pedro A. Rubio, M.D., Medical Center Del Oro, 7800 Fannin, Suite 201, Houston, Texas 77054.
O e v e r a l methods of sternal reapproximation, for which a wide variety of materials are used, have been described. However, wire seems to be the most reliable and the most widely used material for this purpose. Plastic bands 1 * 2 and heavy Dacron 3 have been utilized,
Fig. 1. Close-up view demonstrating tungsten carbide insert and wire position.
Fig. 2. Total length of clamp is 5 inches, providing excellent grip. 449
4 50
Rubio
The Journal of Thoracic and Cardiovascular Surgery
Fig. 3. Two clamps as utilized during operation. Note small piece of wire required and easy maneuverability. as has wire reapproximation of the sternum, which is indeed a strenuous task. It is important for the surgeon to be comfortable and to have an adequate grip on the clamp he is utilizing. For a long time, my colleagues and I have used Kocher clamps, in which the wire is placed at a right angle. This system allows a good grip on the clamp. However, the clamp crowds the operating field and causes problems with glove tearing because of its length and the portions of the wire that stick out, a problem familiar to all cardiac surgeons. We have also utilized a modification of a Kocher clamp.4 The inconvenience of this system, however, is that the grip obtained by this type of modified clamp is not strong enough and allows motion of the wire at the tip of the clamp. In order to help alleviate the problems which we encountered on each case, Codman & Shurtleff, Inc., designed a new instrument: a 5 inch clamp that has a tungsten carbide insert which provides a much better grip and longer wear than stainless steel.* *Codman & Shurtleff, Inc., Randolph, Mass.
Fig. 1 shows the manner in which this clamp holds the wire. We have utilized this clamp in all our median sternotomy cases in the past 6 months and it has proved to be a very useful adjunct to the wire closure of the sternum. Fig. 2 shows the total length of the clamp with the wire in place, and Fig. 3 shows two clamps on both sides of the wire. The tungsten carbide insert is almost as strong as diamond and allows the surgeon to pull as hard as necessary to mobilize the wire adequately before it is twisted. REFERENCES 1 Sanfelippo, P. M., and Danielson, G. K.: Nylon Bands for Closure of Median Sternotomy Incisions: An Unacceptable Method, Ann. Thorac. Surg. 13: 404, 1972. 2 Timmes, J. J., Wolvek, S., Fernando, M., et al.: A New Method of Sternal Approximation, Ann. Thorac. Surg. 15: 544, 1973. 3 Okies, J. E., and Phillips, S. J.: Correspondence, Ann. Thorac. Surg. 17: 423, 1974. 4 Korompai, F. L., Hayward, R. H., and Guinn, G. A.: Clamp for Wire Closure of Sternum, Ann. Thorac. Surg. 21: 249, 1976.