Interlocking Multi-Twisted Wires Versus Interrupted Simple Sternal Wires for Closure of Median Sternotomy

Authors

  • Faisal Mourad, MD, FRCS Cardiothoracic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
  • Ihab Ali, MD, FRCS Cardiothoracic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

DOI:

https://doi.org/10.1532/hsf.3663

Keywords:

interlocking multi-twist, simple closure, sternal dehiscence, wound infection

Abstract

Background: Although closure of a sternotomy incision is usually a simple procedure, failure to do so (sternal dehiscence) is a serious complication and is an independent factor that poses a high degree of morbidity or mortality after open heart surgery. Instability of the bone fragments can lead to complete sternal breakdown, sternal wound infection, and mediastinitis. The stainless-steel encircling wire used as either interrupted simple sutures or as figure of eight sutures is the current standard method of median sternotomy closure. Interlocking multi-twisted sternal wire closure is an alternative that provides rigid sternal fixation. We aim to identify the best method of sternal closure in order to implement it as a standardised protocol for our department.

Methods: Two-hundred patients aged 18-70 years were undergoing cardiac surgeries at Ain Shams University hospitals. They were divided into two groups: Group I included 100 patients with sternal closure using simple wire, and group II included 100 patients with sternal closure using interlocking multi-twisted wires. The day 7, 1 month, and 3 months sternal instability, superficial wound infection, ventilation time, cross-clamp time, length of ICU stay, and length of hospital stay were analyzed.

Results: The incidence of sternal instability on the 7th day, 1 month, and 3 months was significantly higher in the simple wire closure group (P < 0.05). However, incidence of superficial wound infection, length of ICU stay, and duration of mechanical ventilation were comparable between the two groups.

Conclusion: The interlocking multi-twist is a safe, effective, and easily reproducible method for preventing sternal dehiscence.

References

Abboud CS, Wey SB, Baltar VT. 2004. Risk factors for mediastinitis after cardiac surgery. Ann Thorac Surg. 77:676–68.

Alhalawani AM, Towler MR. 2013. A review of sternal closure techniques. J Biomater Appl. 28(4):483-97.

Aykut K, Celik B, Acikel U. 2011. Figure-of-eight versus prophylactic sternal weave closure of median sternotomy in diabetic obese patients undergoing coronary artery bypass grafting. Ann Thorac Surg. 92:638-41.

Bitkover CY, Marcusson E, Ransjo U. 2000. Spread of coagulase negative staphylococci during cardiac operations in a modern operating room. Ann Thorac Surg. 69:1110.

Casha AR, Yang L, Kay PH, Saleh M, Cooper GJ. 1999. A biomechanical study of median sternotomy closure techniques, Eur J Cardio-Thorac Surg. vol. 15 (pg. 365-369).

Dasika UK, Trumple DR, McGovern JA. 2003. Lower sternal reinforcement improves the stability of sternal closure. Ann Thorac Surg. 75:1618.

Dell’Amore A, Domenica G, Stefano C, Giampiero D, Giacomo M, Sofia M, Niccolò D. 2018. Surgical options to treat massive sternal defect after failed Robicsek procedure. J Thorac Dis. 10(6): E410–E415.

Durrleman N, Massard G. 2006. Sternotomy. Multimedia Manual Cardio Thorac.

El Oakley R, Paul E, Wong PS, Yohana A, Magee P, Walesby R, Wright J. 1996. Mediastinitis in patient undergoing cardiopulmonary bypass: risk analysis and midterm results. J Cardiovasc Surg. 38: 595–600.

Glennie S, Shepherd DET, Jutley RS. 2003. Strength of wired sternotomy closures: effect of number of wire twists. Interact Cardiovasc Thorac Surg. 2:3-5.

Goodman G, Palatianos GM, Bolooki H. 1986. Technique of closure of mediansternotomy with trans-sternal figure-of-eight wires. J Cardiovasc Surg. 27:512–3.

Julian OC, Lopez-Belio M, Dye WS, Javid H, Grove WJ. 1957. The median sternal incision in intracardiac surgery with extracorporeal circulation: a general evaluation of its use in heart surgery. Surgery. 42:753–61.

Kotnis-Gqska A, Piotr M, Aldona O, Andrzej S, Malgorzata, Anetta U. 2018. Original Paper: Sternal wound infections following cardiac surgery and their management: a single-centre study. Kardiochirugia Torakochirurgia Polska. 15 (2): 79-85.

Krejca M, Szmagala P, Skarysz J, Bochenek K, Ulczok R, Bis J, et al. 2003. Force distribution in wire sternum sutures: the consequences for sternal closure rigidity. Med SciMonit. 9:134–44.

Loop FD, Lytle BW, Cosgrove DM, Mahfood S, Mc Henry J, Goormastic M, Stewart RW, Golding LA, Taylor PC. 1990. Maxwell Chamberlain memorial paper: Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity and cost of care. Ann Thorac Surg. 49:179-187.

Losanoff JE, Richman BW, Jones JW. 2004. Disruption and infection of median sternotomy: a comprehensive review. Eur J Cardiothorac Surg. 21:831–9.

Negi PC, Kandoria A, Asotra S, Kumar G, Merwaha R, Sharma R, Rao S, et al. 2020. Gender differences in the epidemiology of Rheumatic Fever/Rheumatic heart disease (RF/RHD) patient population of hill state of northern India; 9 years prospective hospital based, HP-RHD registry. Indian heart journal, 72(6), 552-556.

Olbrecht VA, Barreiro CJ, Bonde PN, Williams JA, Baumgartner WA, Gott VL, et al. 2006. Clinical outcomes of noninfectious sternal dehiscence after median sternotomy. Ann Thorac Surg. 82:902–7.

Ramzisham M, Awang RR, Mohd GK, Joanna OSM, Abdullah MF, Mohd DZ. 2009. Interrupted Sternal Wire Closure of Median Sternotomy, Asian Cardiovasc Thorac Ann. 17:587–91.

Shih CC, Shih CM, Su YY, Lin SJ. 2004. Potential risk of sternal wires. European Journal of Cardio-Thoracic Surgery. 25 :812–818.

The Parisian Mediastinitis Study Group. 1996. Risk factors for deep sternal wound infection after sternotomy: a prospective, multicenter study. J Thorac Cardiovasc Surg. Jun;111(6):1200-7.

Published

2021-04-12

How to Cite

Mourad, F., & Ali, I. (2021). Interlocking Multi-Twisted Wires Versus Interrupted Simple Sternal Wires for Closure of Median Sternotomy. The Heart Surgery Forum, 24(2), E363-E368. https://doi.org/10.1532/hsf.3663

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Articles