Asian Cardiovasc Thorac Ann 2000;8:76-77
© 2000 Asia Publishing EXchange Pte Ltd
New Technique For Reinforced Sternal Closure
Ufuk Özergin, MD,
Kadir Durgut, MD,
Cevat Özpinar, MD,
Niyazi Görmü
, MD,
Güven Sadi Sunam, MD,
Tahir Yüksek, MD,
Hasan Solak, MD
Department of Cardiovascular Surgery
University of Selçuk School of Medicine
Konya, Turkey
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For reprint information contact: Ufuk Özergin, MD Tel: 90 332 323 2600/1708 Fax: 90 332 323 2641 email: ozergin{at}selcuk.edu.tr University of Selçuk School of Medicine, Konya 42080, Turkey.
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Abstract
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A simplified method of reinforced sternal closure is described. Figure-of-8-shaped sutures of no. 5 stainless steel wire are inserted with 2 Sterna-Bands between them. The advantages of this technique are simplicity, effectiveness, and speed.
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Introduction
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Since median sternotomy has become the standard approach for open heart operations, there has been an increase in sternal wound complications. Median ster-notomy is also used in some mediastinal and pulmonary procedures. Patients with diabetes, lung disease, obesity, malnutrition, or osteoporosis are at greatest risk of sternal wound complications.1 The greater use of bilateral internal mammary artery grafts has increased the frequency of complications, especially in diabetic patients. The incidence of major wound complications has been reported as 0.7% to 1.9%, with a mortality rate of 10.3% to 39.6%.2
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Technique
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A no. 5 stainless steel wire is placed on the sternal manubrium in a figure-of-8 fashion. A Sterna-Band (B-220 surgical steel sternal band; Stony Brook Surgical Innovations, Inc., Stony Brook, NY, USA) is placed on the sternum by passing front to back and back to front, 15 to 20 mm from the sternal edges (Figure 1
). Another stainless steel suture is placed simply or in a figure-of-8 shape, according to sternal length. A second Sterna-Band is placed as before, followed by a final figure-of-8-shaped stainless steel wire suture. The stainless steel wires are tightened first and then the Sterna-Bands (Figure 2). With this technique, maximal sternal stability is achieved in both the vertical and transverse axes of the upper and lower sternum.
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Discussion
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Major wound complications such as mediastinitis, osteomyelitis, and chondritis, which are usually secondary to sternal dehiscence, prolong hospitalization and increase mortality.3 The most important factor in avoiding these complications is to achieve maximum sternal stability by fixing both the vertical and transverse axes.4 A number of techniques have been described for sternal closure following sternotomy.5,6 The advantage of this technique is that the Sterna-Band gives maximal sternal stability to both the edges and the axes, by applying less pressure to the sternum over a larger surface.
We used this technique in 84 patients who had risk factors of obesity, diabetes, lung disease, bilateral internal mammary artery grafts, or precarious sternum. No sternal dehiscence was encountered; there were 4 cases of superficial sternal wound infection that were successfully treated with antibiotics and simple drainage. This technique was used in a 52-year-old man with obstructive lung disease who had undergone coronary artery bypass grafting. In the early postoperative period, external cardiac massage was applied for 10 minutes because of asystole. There was no sternal dehiscence or major wound complication.
We believe that use of this method in high-risk patients could reduce the incidence of major sternal complications and decrease mortality rates. The technique is easy to perform and it provides good stability with tension distributed equally over the entire sternal surface.
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References
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Scovotti CA, Ponzone CA, Leyro-Diaz RM. Reinforced sternal closure. Ann Thorac Surg 1991;51:844–5.[Abstract]
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Tavilla G, van Son JAM, Verhagen AF, Lacquet LK. Modified Robicsek technique for complicated sternal closure. Ann Thorac Surg 1991;52:1179–80.[Abstract]
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Ottino G, De Paulis R, Pansini S, Rocca G, Tallone MV, Comoglio C, et al. Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive procedures. Ann Thorac Surg 1987; 44:173–9.[Abstract]
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Chlosta WF, Elefteriades JA. Simplified method of reinforced sternal closure. Ann Thorac Surg 1995;60: 1428–9.[Abstract/Free Full Text]
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Robicsek F, Daugherty HK, Cook JW. The prevention and treatment of sternal separation following open heart surgery. J Thorac Cardiovasc Surg 1977;73:267–8.[Abstract]
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Al-Ebrahim K, Shafei H. New technique for reinforced sternal closure. Asian Cardiovasc Thorac Ann 1996; 4:117–8.
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Abstract
Introduction
