Rultract GEN4 SMLH Updated REDO Resternotomy Assist L скачать в хорошем качестве

Rultract GEN4 SMLH Updated REDO Resternotomy Assist L

The Rultract Resternotomy Retractor allows for a stable sternal reentry platform with clear and sustained visualization of the structures on the underside of the sternum. The underside of the sternum in the midline is now clearly visualized thus facilitating subxiphoid dissection. Specific advantages of this retractor include: 1. Direct visualization of the underside of the sternum. The rakes are positioned on opposite sides of the costal margin and the patient placed in Trendelenburg position allowing full visualization of the subxiphoid space and the underside of the sternum. This makes for a very stable dissecting platform. 2. Reduced need for positioning and repositioning. Since sternotomy with the oscillating saw can be performed in between the rakes, dissection can be performed with little interruption. The rakes of the retractor are only repositioned to the mid-sternum once dissection is no longer possible either because tissues are out of reach of the electrocautery tip or if visualization of the superior- most portion of the sternum becomes poor. Because the rakes can be separated in a controlled a fashion, a wide plane of dissection can be performed underneath the sternum. 3. Minimized error and inadvertent injury from fatigue. Invariably, both the surgeon and assistants would need to lift retractors manually to facilitate dissection. This can lead to injury if positioning cannot be sustained or if there is any unexpected movements. Cardiac structures can also be injured if vigorous lifting is done while the structures are adhered to the sternum. This retractor helps avoid those injuries. REYES ET AL. | 3 4. Applicable to all patients ages. The variety of retractor sizes (18, 12, and 8 mm) permits use of this retractor for all patients in all age groups. This approach has become the standard approach for sternal reentry at our institution. Programs adopting this technique can utilize the standard Skyhook retractor system currently in use for internal mammary artery harvest and exchange the mammary rakes for the resternotomy retractor piece (Figure 2) which is now currently available. Since January 2013, we have performed 363 redo sternotomies in both adult and pediatric congenital cardiac cases using this retractor. Preemptive groin exposure and peripheral cannulation is performed when cardiac structures are densely adherent, and we have not required the need for emergent peripheral cannulation using this approach. CONCL U S I ON Reoperative sternotomy with the Rultract Resternotomy Retractor™ provides a safe, reliable, and consistent method for sternal reentry. This technique can be used in all age groups of patients with both acquired and congenital heart disease, irregardless of the number of previous sternotomies.