A New Technical Approach for Sternal Closure with Suture Anchors (Dogan Technique)


  • Omer Faruk Dogan
  • Ali Oznur
  • Metin Demircin




Objectives: Various methods for sternal approximation have been described previously. Some patients undergoing these procedures are at risk for sternal dehiscence and mediastinitis. We used a different method, with a suture anchor system, for median sternotomy closure as an alternate technique in patients with a high risk of postoperative sternal dehiscence and sternal nonunion.

Material and Method: Suture anchor systems have been developed principally for the fixation of tendons or ligaments to the bone. We first used the suture anchor system for median sternotomy closure, although it has been frequently used in various orthopedic surgical procedures. In this report, we describe the use, after fresh cadaveric tests, of an alternative technique in a patient undergoing coronary artery bypass grafting.

Results: There were no complications due to the suture anchor device, and successful application was performed for sternotomy fixation after surgical procedure in a patient. The standard techniques have several disadvantages, such as osteomyelitis, chondritis, cutting into the sternum and sternal dehiscence, prolonged hospitalization, and increased mortality and morbidity due to the listed complications, but these devices may protect the wire from cutting into the sternal bone.

Conclusion: We propose suture anchors for reapproximation of the sternum to decrease the complications related to surgical steel wires. We therefore consider this technique to be easy, safe, and effective in patients with diabetes mellitus or severe osteoporosis considered to have risk for sternal dehiscence postoperatively. Another advantage of this suture system is that the titanium wire makes it more magnetic resonance compatible than systems using surgical steel wire.


Stahle E, Tammalin A, Bergstroom R, Hambreus A, Nystrom SO, Hanssen HE. 1997. Sternal wound complications-incidence, microbiology and risk factors. Eur J Cardiovasc Surg 11:1146-53.nTavilla G, van Son JA, Verhagen AF, Lacquet LK. 1991. Modified Robiscek technique for complicated sternal closure. Ann Thorac Surg 52:1179-80.nPuc MM, Antinory C, Villanueva DT, Tarnoff M, Heim JA. 2000. Ten year experience with mersilene-reinforced sternal wound closure. Ann Thorac Surg 70:97-9.nRobicsek F, Daugherty HK, Cook JW. 1977. The prevention and treatment of sternal separation following open heart surgery. J Thorac Cardiovasc Surg 73:267-8.nSanfelippo PM, Danielson GK. 1972. Complications associated with median sternotomy. J Thorac Cardiovasc Surg 63:419-23.nSchreffler AJ, Rumisek J. 2001. Intravascular migration of fractured sternal wire presenting with hemoptysis. Ann Thorac Surg 71:1682-4.nScovotti CA, Penzone CA, Leyro-Diaz RM. 1991. Reinforced sternal closure. Ann Thorac Surg 51:844-5.nSerry C, Bleck PC, Javid H, Hunter JA, Goblan MD, Delaria GA. 1980. Sternal wound complications, managements, and results. J Thorac Cardiovasc Surg 80:861-6.nSirivelle S, Zikria EA, Ford WB, Samadeni SR, Miller WH, Sullivan ME. 1987. Improved technique for sternal closure of median sternotomy incision: mersilene tapes versus standard wire closure. J Thorac Cardiovasc Surg 94:591-5.nCampo CD, Heimbecker RO. 1982. Repair of refractory sternal dehiscence: a new technique. J Thorac Cardiovasc Surg 83:937-8.nCohen CDJ, Griffin LF. 2002. A biomechanical comparison of three sternotomy closure techniques. Ann Thorac Surg 73:563-8.nDasika UK, Trumble DR, Magovern JA. 2002. Lower sternal reinforcement improves the stability of sternal closure. Ann Thorac Surg 75(5):1618-21.nGoldman G, Nostel R, Spir E, Vidne B. 1998. Effective technique of sternum closure in high risk patients. Arch Surg 123:386-7.nHendrichsen SC, Keger KE, Morea CJ, Aperte RL, Smith PK, Levin LS. 1996. Sternal plating for the treatment of sternal non-union. Ann Thorac Surg 62:512-8.nJohnson RH, Garcia-Rinaldi R, Vaughan GD, et al. 1985. Mersilene ribbon closure of the median sternotomy: an improvement over wire closure. Ann Thorac Surg 39:88-9.nMcGregor WE, Trumble DR, Magovern JA. 1999. Mechanical analyses of midline sternotomy wound closure. J Thorac Cardiovasc Surg 117:1144-50.nNegri A, Manfredi J, Terrini A, Rodella G, Bisleri S, Muneretto C. 2002. Prospective evaluation of a new sternal closure method with thermoreactive clips. Eur Cardiothorac Surg 22:571-5.nOttino G, De paulis R, Pansini S, et al. 1987. Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive procedures. Ann Thorac Surg 44:173-9.nOzaki W, Buchmann SR, Lannettoni MD, Frankenburg EP. 1998. Biomechanical study of sternal closure using rigid fixation techniques in human cadavers. Ann Thorac Surg 65:1660-5.nOznur A. 2002. A new technique for fixation of distal chevron osteotomy. Foot Ankle Int 23(10):954-5.nParisien Mediastinitis Study Group (PMSG). 1996. Risk factors for deep sternal wound infection after sternotomy. A prospective, multicenter study. J Thorac Cardiovasc Surg 111:1200-7.nBarber FA, Herbert MA, Click JN. 1995. The ultimate strength of suture anchors. Arthroscopy 11(1):21-8.nBitkover CY, Gardlund B. 1998. Mediastinitis after cardiovascular surgery operations: a case control study of risk factors. Ann Thorac Surg 65:36-40.nBlanchard A, Sadeghi H. 1995. Incidence of deep sternal infection after open heart surgery: a ten years retrospective study from 1981 to 1991. Eur J Thorac Cardiovasc Surg 9:153-7.n



How to Cite

Dogan, O. F., Oznur, A., & Demircin, M. (2005). A New Technical Approach for Sternal Closure with Suture Anchors (Dogan Technique). The Heart Surgery Forum, 7(4), E328-E332. https://doi.org/10.1532/HSF98.20041038




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