A revolutionary method of closing sternal osteotomies
From Ask Dr Wiki
Contents |
The Talon (Rapid Sternal Closure System)
Definition
The newest device to hit the heart surgery field is called the Talon. It is a system of rigid fixation that has been implemented to replace the technique of using wires to close a sternum that has been split to allow access to the heart or other chest areas.
History
The concept of rigid fixation hit the fields of orthopedic and reconstructive surgery in the early 1980's. Before that all fractures were treated with wire fixation. Then suddenly the concept of rigid fixation came into being. From the time of initial introduction in the early 1980's until 1990, the use of wires rapidly lost popularity until it was clearly shown that rigid fixation yielded less pain, motion and fewer complications than wires.
Until recently, sternum closures were done entirely with wiring techniques. However, with its premier introduction, the Talon was used successfully for sternum closure in 10 patients. These patients have all done extremely well and experienced uneventful post-operative recuperations. The general consensus is that there has been less pain, fewer hospital days post-surgically, and even more importantly, more stability of the sternum post surgery.
The use of the Talon has now been approved by the FDA. Since then, there have now been an additional 40+ patients who have had the device placed. The patients have been all high risk in nature. To date (Jun 2007), there have been no failures of the device and two re-entries with no untoward events.
Example cases
Examples of patients are included in the following four presentations:
- An incomplete 250 pound paraplegic, who could ambulate only with crutches and braces, needed a cardiovascular bypass, and it was decided to use the Talon for sternal stabilization. He underwent a bypass procedure that was uncomplicated and was up on his crutches two days post-operatively. This would not have been possible with sternal wiring.
- A patient had multiple wire failures and a fractured sternum resulting from those wires. His incision was opened and the sternal surface was exposed. The wires were removed and without elevating the sternum from the underlying tissues, the Talon was applied. This was heretofore impossible. The sternum was stabilized with the placement of three Talon devices and the skin was closed. The patient was discharged the next day with a simple drain.
- An elderly female had an unstable sternum for two years with two failed redo's with surgical wiring attempts. She underwent the incision, removal of the wires, and placement of two Talon devices. The skin was closed and the patient insisted on discharge the same day as she was more comfortable than she had been in years.
- A 300 pound patient had a cardiac bypass with three vessels done. Her post-operative course was complicated with acute tubular necrosis, but with the use of the Talon she stabilized. She was discharged with a stable sternum, and no signs of sternal pain.
Summary
The Talon has also been proposed to assist the combat surgeon in that it will allow quicker closures of chest injuries, thus assisting surgeons in performing chest procedures not heretofore done because of the inherent instability of wire closures. Further, it has been shown that its stability and strength will assist materially those persons with osteoporosis who had previously suffered from fractures and the wires actually cutting through their sternums as a cheese cutter might through cheese. It is known that the application of wires has resulted in some post-operative bleeding. But since the Talon does not penetrate bone, it is proving that the incidence of emergency surgical take backs will also decrease because of the safety and lower incidence of damage to the sternum and its surrounding muscles and tissues. Duke University is holding a unique training course in the use of this device, and several European and American centers, such as in Vienna Austria and New York University in New York, are soon to have the device available to those patients who have sufficient risk factors that would warrant its application. It is already available, or soon will be, at other hospitals in New York, Boston, Atlanta, Charlotte, Austin, and Tulsa with more hospitals joining soon. Finally, it is estimated that the over 100,000 persons who have had unstable, painful sternums resulting after the use of wires may now have a way of releasing them from their discomfort. It is possible that the Talon may result in the widespread relief of these patients' problems over the next few years. The product is being produced by an American company, KLS Martin, with actual construction by a German firm, and it has been designed and patented by an American physician.
References
This article was prepared by Dr. Arch S. Miller III, MS, MD, FAAP, FACS
Chairman, Section Plastic Surgery, Saint Francis Hospital, Tulsa, Oklahoma
Office: 918-492-2282, Fax: 918-491-9188
Links
[KLS Martin RSC Talon Rapid Sternal Closure page] [KLS Martin RSC Talon placement technique video]
Last edited: May 22, 2013
