{"id":6891,"date":"2011-09-20T14:57:14","date_gmt":"2011-09-20T19:57:14","guid":{"rendered":"http:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/?p=6891"},"modified":"2019-02-26T20:10:30","modified_gmt":"2019-02-27T01:10:30","slug":"sternal-plating-rigid-fixation-jai-raman","status":"publish","type":"post","link":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/2011\/09\/20\/sternal-plating-rigid-fixation-jai-raman\/","title":{"rendered":"Video: &#8220;Besides Sternum Wires, What Other Technologies Can Help The Chest Heal?&#8221; Asks Jane"},"content":{"rendered":"<p>As a follow-up to our recent discussion about <a href=\"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/2011\/08\/23\/pain-chest-sternum-wires-lishan-aklog\/\">chest pain and sternum wires<\/a>, Jane sent me a great question about incision closure techniques. She writes, &#8220;Hi Adam &#8211; I\u2019ve read good and bad things about the use of wires to close the sternum.\u00a0 Are there any other technologies used to help the chest heal? Thanks, Jane&#8221;<\/p>\n<p>Luckily, I was able to ask this exact question to <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Jai-Raman-Chicago-Illinois.php\">Dr. Jai Raman<\/a>, the Chief of Cardiac Surgery at Rush University Medical Center, in Chicago, Illinois. I thought you might like to see the interview highlights from our discussion about a new technology called sternal plating.<\/p>\n<p>&nbsp; <\/p>\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/c1HZppBQg6o\" frameborder=\"0\" allowfullscreen><\/iframe><\/p>\n<p>&nbsp; <\/p>\n<p><!--more--><\/p>\n<p>Thanks to Jane for her question <span style=\"text-decoration: underline;\">and<\/span> a special thanks to Dr. Jai Raman for taking the time to share his clinical experience and research about sternal plating and rigid fixation for open heart surgery patients.<\/p>\n<p>For those members of our community who are hearing impaired, I have provided a written transcript of this video interview below:<\/p>\n<p>Adam:\u00a0 Hi, everybody.\u00a0 It\u2019s Adam and I\u2019m coming to you from AATS in Philadelphia, very excited to be here with Dr. Jai Raman who\u2019s a professor of surgery at the University of Chicago and we\u2019ve got a great question for Dr. Raman and it\u2019s from Jane and she writes, \u201cAdam, I\u2019ve been told that I\u2019ll need heart valve surgery within the next 24 months due to aortic regurgitation.\u00a0 I\u2019ve read good and bad things about the use of <a href=\"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/2007\/10\/29\/sternum-wires-and-heart-surgery-aka-sternal-wires\/\">wires to close the sternum<\/a>.\u00a0 Are there any other technologies used to help the chest heal?\u201d<\/p>\n<p>Dr. Raman:\u00a0 So that\u2019s a very good question.\u00a0 Jane, if you can imagine the bone, the breastbone, sets like this and this is what we\u2019ve got to get through to get into your chest to do the surgery.\u00a0 Historically, when cardiac surgery first became a specialty, the bone was lashed together with wire and so pioneering cardiac surgeons in the 50\u2019s and 60\u2019s actually used wire to, you know, circle around the bone and keep it together.\u00a0 Orthopedic surgery, plastic surgery, neurosurgery, they\u2019ve all developed techniques where instead of using wire to go around the bone, we actually use plates and if you can imagine doing carpentry at home over the weekend, you\u2019d never consider lashing two bits of wood together with wire.\u00a0 It\u2019s not very effective if you want it to keep moving all the time.\u00a0 So even technically from carpentry or remodeling, do it stuff at home, you know that when you do a joins, you know, around window frames, you use plates and screws so all other bones in the body are handled with plates and screws.\u00a0 That\u2019s piece of bone in the cheek, bone in your arm, anywhere.\u00a0 So I think that the plate advancement at the the University of Chicago was the plastic surgeons in the mid-90\u2019s told us that this is the best way to close bone, especially in high risk patients.\u00a0 So we adopted this and in the past, maybe eight years, we developed, refined and expanded this to improve it as a standard treatment for closing bone so much of the patients have lots less pain.\u00a0 They\u2019re able to get back on their feet much quicker and it\u2019s also facilitated the ability to do all these small incisions.\u00a0 So if you can imagine, going back to that breastbone and sternum as it sits like this in your chest, these are the plates and screws I was talking about so this plate is screwed in to the bone \u2013 The plate, like this, is screwed in to the bone and this makes it really solid so when the bone is doing the bone healing is lack of movement and you can imagine the chest is constantly moving.\u00a0 You\u2019re breathing.\u00a0 You\u2019re coughing.\u00a0 You\u2019re sneezing.\u00a0 All those things hurt like Hell and I\u2019m sure Adam can attest to that.<\/p>\n<p>Adam:\u00a0 The <a href=\"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/2007\/11\/17\/best-piece-of-advice-watch-out-for-that-first-sneeze\/\">sneezing after heart surgery<\/a> in particular.<\/p>\n<p>Dr. Raman:\u00a0 Yeah.\u00a0 So when you actually have something that\u2019s fixed surgically, that\u2019s what we call <em>rigid fixation<\/em>, with plates and screws, that little bit of movement is reduced and so patients actually have a much better chance of healing and healing effectively.\u00a0 So now if you can imagine, let\u2019s take this one step further.\u00a0 The aortic valve sits in this upper portion up here so there\u2019s so there\u2019s no real need for you to go all the way down here.\u00a0 Let\u2019s say we just make a small T-shaped incision (<a href=\"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/2008\/09\/23\/mini-sternotomy-for-aortic-valve-replacement\/\">mini-sternotomy)<\/a> in the bone.\u00a0 It\u2019s so much easier to fix this with plates than with wires because with wires, it\u2019s too \u2013 It\u2019s hard for the bone to come together and, you know, align together quickly.\u00a0 Plates and screws, it\u2019s actually facilitated us, our &#8211; expanded our ability to do all these complex operations with small incisions.\u00a0 So that is the big benefit of using plates and screws and we do it even for other things.\u00a0 We do it in the side.\u00a0 We can actually make a crack in the rib (<a href=\"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/2009\/03\/04\/mini-thoracotomy-aortic-valve-repacement\/\">mini-thoracotomy<\/a>), you know.\u00a0 It sounds bad but it actually completely takes away the pain because we fix it at the end with a small plate across the rib.\u00a0 So those are the differences in terms of bone fixation for a patient&#8217;s recovery.<\/p>\n<p>Adam:\u00a0 Great.\u00a0 Well, thanks, Dr. Raman, for sharing that with.\u00a0 I hope that helped all you out there.\u00a0 I know I learned a lot and you\u2019ve used this with folks like Danny Thrall, the swimmer, if I remember right.<\/p>\n<p>Dr. Raman:\u00a0 Yes.<\/p>\n<p>Adam:\u00a0 The swimmer.\u00a0 So thanks for all that you do at the University of Chicago and stopping by with us today.\u00a0 We really appreciate it.<\/p>\n<p>Dr. Raman:\u00a0 Thank you.<\/p>\n<p>Adam:\u00a0 Take care.<\/p>\n<p>Keep on tickin!<br \/>\nAdam<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":22534,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[62],"tags":[],"class_list":["post-6891","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-recovery"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/posts\/6891","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/comments?post=6891"}],"version-history":[{"count":0,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/posts\/6891\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/media\/22534"}],"wp:attachment":[{"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/media?parent=6891"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/categories?post=6891"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/wp-json\/wp\/v2\/tags?post=6891"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}