Özet:

Sternal separation is one of the most complicated complications after heart surgery. Although sternal separation can be treated by simple methods when detected in the early stages, failure or delay in treatment can result in mediastinitis, which is quite fatal. In this study, the characteristics of alternative sternum closing methods, primarily the sterna clothes and titanium sterna plates, were studied.  Patients and Method: The study included patients developing sternum separation after open heart surgery for any reason between April 2015 and January 2018. Patients were studied retrospectively in terms of demographic characteristics, risk factors for sternal separation, types of operation and sternum stabilization methods, especially with sternal pencil and titanium sternal plaque. Results: In total, 45 patients were taken to surgical stabilization surgery with a cause of sterna separation.  Thirty-four (75.6%) were sick men, 11 (24.4%) were sick women. The average time from the first operation to the development of sternum separation was 68.5 days (1-780 days). The average body-mass index was 31.52 kg/m2 (22.03-43.69 kg/m2). The Sternal prefixation average CRP was 68.34, while the prefixation was 75.55. The risk factors accompanying coronary artery disease were identified as internal mammal artery (IMA), diabetes mellitus (DM), asthma, chronic obstructive lung disease and aging. The average postoperative intensive care stay period was 5.02 days (1-29 days), while the hospital stay period was 17.18 days (2-74 days). In three patients (6.67) early periods of mortality were observed. The first preferred method in the operation was the simple closing and/or Robicsek method, while 24 patients (53.3%) used sternal pencil and/or titanium plate methods. DM increases the total post-operative deposit periods with both hospital and intensive care stay periods. DM also increases the risk of developing surface and deep sternal infection (p<0.05). The ideal sternal closing technique should be cost-effective, while stabilizing the sternum, with minimal post-operative complications, providing the shortest hospitalization time possible. In patients with a solid interkostal range, sternal pencil allows for the elimination of serious complications such as cardiovascular retardation, often caused by tight adhesions.  Sternal plates are very effective, especially in fragile fractures without stable interkostal intervals. All patients should be treated by assessment according to the types of injury and fractures in the sternum.