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J Thorac Cardiovasc Surg 2003;126:1113-1120
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Gelatin sheet incorporating basic fibroblast growth factor enhances sternal healing after harvesting bilateral internal thoracic arteries

^a Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
^c Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
^b Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
^d College of Medical Technology, Kyoto University, Kyoto, Japan

Received for publication July 8, 2002; revisions received September 11, 2002; revisions received September 30, 2002; accepted for publication October 18, 2002.

^* Address for reprints: Masashi Komeda, MD, Professor and Chairman, Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Japan 606-8507.
masakom{at}kuhp.kyoto-u.ac.jp

OBJECTIVE: We previously reported that a gelatin sheet incorporating basic fibroblast growth factor accelerated sternal healing after bilateral internal thoracic artery removal in normal and diabetic rats. The aim of this study was to evaluate the effects of this therapeutic modality on sternal healing in a large-animal model before performing a clinical trial.

METHODS: After median sternotomy and bilateral internal thoracic artery removal in a pedicled fashion, 14 beagle dogs received either a gelatin sheet incorporating basic fibroblast growth factor (100 µg per sheet) on the posterior table of the sternum (FGF group, n = 7) or did not receive a gelatin sheet (control, n = 7). We compared sternal healing 4 weeks after surgical intervention between the groups.

RESULTS: Scintigraphic images obtained by using technetium 99 methylene diphosphonate bone scanning were assessed visually, and the impulse rate was quantified 30 and 60 minutes after injection of technetium 99 methylene diphosphonate to evaluate the sternal perfusion. Sternal uptake was significantly increased in the FGF group (30 minutes: 221% ± 30% vs 180% ± 36%; 60 minutes: 267% ± 26% vs 197% ± 42%; P < .01). Apparent sternal dehiscence, as assessed radiographically, was observed only in the control animals. Histologically, complete healing of the sternum with marked angiogenesis was observed in the FGF group, whereas poor healing with limited angiogenesis was seen in the control animals. Both bone mineral content (134 ± 49 vs 52 ± 32 mg, P < .01) and bone mineral density (133 ± 53 vs 66 ± 32 mg/mm², P < .05) along the incision line of the sternum, as assessed by means of dual-energy x-ray absorptometry, were higher in the FGF group.

CONCLUSIONS: A gelatin sheet incorporating basic fibroblast growth factor enhances sternal perfusion and accelerates sternal bone healing in large animals.

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