[A new method for closure of median sternotomy: applications of a stapler system]

Power driven staples were used in 20 patients for median sternotomy closure, and the staples were evaluated for clinical fixation. In each case four to six staples and two wires were used to secure closure. Clinically, in one patient prolonged sternal flail was observed, but this disappeared after six weeks. In the remaining 19 patients, good sternal fixation was secured. No cases required surgical procedures such as refixation of the sternum or removal of the staples. As a means of assessing the status of "backing out", which is a major cause of poor fixation, the backing out part of the staple leg was measured from lateral sternal radiographies. The ratio of the backing out portion to the staple leg, the backing out ratio (BOR), was calculated. The average BOR was found to be 32.7 +/- 21.4% (n = 102). The BOR was 70% or less in 91.2% of all staples, and 70% or more in 8.8%. The fragility of the sternum, poor sternal connection and inadequate technique to drive were suspected as factors accountable for backing out. In conclusion, the stapler system seems to be useful for sternal fixation and will become even more after improvement of the staple size and technical modifications to assure better connection at the driven site.