A review of sternal closure techniques

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Surgical Innovation

Background:

• Median sternotomy is a common approach for cardiac surgery, necessitating reliable sternal closure.
• Inadequate sternal fixation can lead to significant post-operative complications, including morbidity, mortality, and increased healthcare costs.
• Despite its prevalence, sternal closure techniques require continuous evaluation for improved patient outcomes.

Purpose of the Study:

• To conduct a comprehensive literature review on surgical tools for sternal fixation after median sternotomy.
• To evaluate in vivo, in vitro, and clinical data on various sternal closure methods.
• To compare the efficacy and safety of different sternal fixation techniques.

Main Methods:

• Systematic review of existing literature on sternal fixation techniques.
• Analysis of studies evaluating wiring, interlocking, plate-screw, and cementation methods.
• Inclusion of in vivo, in vitro, and clinical trial data.

Main Results:

• No single sternal closure technique has achieved widespread adoption.
• Wiring and plating techniques showed increased serious post-operative complications in high-risk patients.
• Plating and interlocking systems demonstrated superior stability and reduced complication rates compared to wiring.
• Limited studies exist on interlocking systems and cementation with wires.

Conclusions:

• Plating and interlocking sternal fixation methods are more effective than wiring for stability and reducing complications.
• Further clinical studies and long-term follow-up are essential to validate these findings.
• The ideal sternal closure should balance stability, low complication rates, short hospitalization, and cost-effectiveness.