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


  • 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



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


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.


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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.