The Simple Technique of Sternal Closure Using An Absorbable Mesh Plate
DOI:
https://doi.org/10.1532/hsf.4443Keywords:
sternal closure, mesh plate, sternal fixationAbstract
Background: Several authors have investigated various sternal closure materials and technologies for sternal fixation; nonetheless, the optimal technique for primary sternal closure remains unclear. This study aimed to evaluate the sternal stability of a simple technique using a mesh-type plate (Super Fixorb MX40®; Takiron Co. Ltd., Osaka, Japan), as compared with wire cerclage.
Methods: A total of 70 patients who underwent cardiovascular surgery through median sternotomy between July 2019 and May 2020 were included. Two pieces of mesh-type plates were placed under the sternum in combination with wiring. The technique for sternal closure was randomly applied, which was mainly based on the surgeon’s preferences: mesh plate (mesh group: N = 33) or conventional wire cerclage (wire group: N = 37). Sternal displacement was measured using computed tomography at discharge.
Results: Pain scale scores and analgesic use on postoperative day 7 were similar between the two groups. However, the displacement in both the anterior-posterior and lateral directions was significantly smaller in the mesh group.
Conclusions: The use of the mesh plate device for sternal closure is simple, safe, easy, and potentially reliable without anterior-posterior sternal displacement.
References
Alhalawani AM, Towler MR. 2013. A review of sternal closure techniques. J Biomater Appl. 28:483-97.
Allen KB, Thourani VH, Naka Y, et al. 2017. Randomized, multicenter trial comparing sternotomy closure with rigid plate fixation to wire cerclage. J Thorac Cardiovasc Surg. 153:888-96.
Kuroki H, Arai H, Srisont S, et al. 2020. Corrugated Sheet of Unsintered Hydroxyapatite Poly-L-Lactide for Sternal Fixation: A Preclinical Study. Ann Thorac Cardiovasc Surg. 26:40-6.
Matsuyama K, Kuinose M, Koizumi N, Iwasaki T, et al. 2016. Sternal closure by rigid plate fixation in off-pump coronary artery bypass grafting: a comparative study. J Artif Organs. 19:175-8.
Morimoto K, Matsushita T, Masuda S, et al. 2021. The Novel Technique of Sternal
Closure With Absorbable Mesh for Osteoporotic Patients. Heart Lung Circ. 30:e65-7.
Nenna A, Nappi F, Dougal J, et al. 2019. Sternal wound closure in the current era: the need of a tailored approach. Gen Thorac Cardiovasc Surg. 67:907-16.
Saito T, Iguchi A, Sakurai M, et al. 2004. Biomechanical study of a poly-L-lactide (PLLA) sternal pin in sternal closure after cardiothoracic surgery. Ann Thorac Surg. 77:684-7.
Snyder CW, Graham LA, Byers RE, et al. 2009. Primary sternal plating to prevent sternal wound complications after cardiac surgery: early experience and patterns of failure. Interact Cardiovasc Thorac Surg. 9:763-6.
Tam DY, Nedadur R, Yu M, Yanagawa B, et al. 2018. Rigid Plate Fixation Versus Wire Cerclage for Sternotomy After Cardiac Surgery: A Meta-Analysis. Ann Thorac Surg. 106:298-304.
Tugulan CI, Spindel SM, Bansal AD, et al. 2020. Does Elective Sternal Plating in Morbidly Obese Patients Reduce Sternal Complication Rates? Ann Thorac Surg. 110:1898-903.
Wilkinson GA, Clarke DB. 1988. Median sternotomy dehiscence: a modified wire suture closure technique. Eur J Cardiothorac Surg. 2:287-90.
