About Robicsek Technique
What is Robicsek Technique?
What is Robicsek Technique?
Today, Median Sternotomy has become the standard approach for most of the cardiac and mediastinal surgical procedures, such as, heart transplant, congenital heart defects or coronary artery bypass surgery. Therefore, there has been an increase in sternal wound complications, since the commencement of Median Sternotomy.
To achieve maximum sternal stability, the use of Robicsek Technique has been followed with good results.
This technique consisted of wrapping wires twice around each rib head and placing standard circumferential wire sutures, thus providing full stability by decreasing the load on the sternum using only steel wires.
Four stainless steel wires are placed parasternally on both sides. The first wire is then passed through the manubrium through the second intercostal space. Then it twisted to form a ring. The second wire is then placed through the second and third intercostals spaces in an interlocking fashion. The procedure is done until the interlocking process is reached the end of the sternum. The procedure is individually tailored based on the extent and location of the complication.
The interlocking creates a chain on both sides of the sternum. Further, two transverse trans-manubrial wires are placed laterally to both parasternal wires. Also, the transverse sternal wires are also placed to reach the fifth intercostal space. This helps in avoiding injury to mammary vessels.
Ultimately, the transverse wires are tightened providing lateral strength to the sternum closure.
How does it help?
The technique is useful in stabilizing complicated sternal dehiscence, especially in the presence of multiple transverse fractures of the sternum. The technique is easy to perform and it provides good lateral stability. Once the interlocking is done, a cage is formed and tightened it distributes the tension to the entire sternal surface.
Who is the best candidate?
One of the factors for the development of sternal wound infection is bony instability after sternotomy. Hence, in patients with an increased risk for sternal instability and wound infection after cardiac or median sternotomy, the Robicsek Technique can be effective. Patients with osteoporotic sterna who have complete sternal dehiscence with multiple transverse sternal fractures developed postoperatively due to severe coughing are also the best candidate to use this technique.
There are risks of any surgical procedure, including Robicsek Technique. The technique can cause chest pain and blood loss to the patients. In some rare cases infection can also harm to the patients who have undergone Robicsek Technique.
What is the Cost?
Robicsek Technique is a very cost-effective treatment for congenital heart defects or coronary artery bypass surgery. It may cost around $550.