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Updated: Jan 5, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Comparison between noninvasive and conventional skin closure methods in off-pump coronary artery bypass grafting
Heemoon Lee1, Sang Yoon Yeom1, Hee Jung Kim1
1Departments of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon-si, Gyeonggi-do, Korea.
Insights
Zip surgical skin closure devices significantly reduced superficial sternal wound complications compared to sutures in coronary artery bypass grafting. This innovative approach offers a safer alternative for patients undergoing bilateral internal thoracic artery procedures.
Area of Science:
- Cardiovascular Surgery
- Wound Management
- Medical Devices
Background:
- Sternal wound complications increase healthcare costs and patient dissatisfaction.
- Mediastinitis is a life-threatening risk, particularly after coronary artery bypass grafting (CABG) using bilateral internal thoracic arteries (BITAs).
- Variability in surgical skill can contribute to wound complications, highlighting the need for standardized closure techniques.
Purpose of the Study:
- To compare the incidence of sternal wound complications between a non-invasive zip surgical skin closure device and conventional suture closure.
- To evaluate the efficacy of zip surgical skin closure devices in reducing wound complications after CABG.
Main Methods:
- A study included 379 patients undergoing off-pump coronary artery bypass grafting (OPCAB) with BITAs.
- Patients were divided into a Zipline group (N=100) and a conventional suture group (N=279).
- Propensity score matching was used to create comparable groups for analysis.
Main Results:
- While initial demographics differed, propensity score matching yielded comparable groups.
- The zip group showed a significantly lower incidence of superficial sternal wound infection or dehiscence (1.1% vs. 7.1%, P=0.036) compared to the conventional group.
- Multivariable analysis indicated the zip device had a preventive effect against wound complications (OR: 0.128, P=0.029).
Conclusions:
- Zip surgical skin closure devices are effective in reducing superficial wound complications.
- This non-invasive device offers an improved alternative to conventional sutures for sternal closure in OPCAB using BITAs.
- Standardization with zip devices may mitigate surgeon-dependent variability in wound closure outcomes.
Background:
Sternal wound complications could increase the hospital cost while decreasing the satisfaction of surgery. Furthermore, it can potentially also lead to life-threatening mediastinitis especially after coronary artery bypass grafting using bilateral internal thoracic artery (BITA). Skill levels of suture technique vary among surgeons and may contribute to an increased wound complication rate. Thus, standardization of surgical wound closure could potentially decrease the surgeon factor. The aim of the study is to compare the wound complication rate between non-invasive surgical skin closure devices (zip surgical skin closure device, Zipline Medical, Campbell, CA, USA) and conventional suture closure.
Methods:
Three hundred seventy-nine patients who underwent off-pump coronary artery bypass grafting (OPCAB) using BITAs at our institution between 2016 and 2018 were included in this study. Patients were divided into two groups; the Zipline group (zip-group, N=100), and conventional group (con-group, N=279). Following propensity score matching, 95 con-group patients were matched to 169 zip-group patients.
Results:
The average age and history of cancer were significantly higher in the zip-group (P=0.021 and P=0.023, respectively). However, after propensity score matching, no differences were observed in the demographic data between the groups. In total patients (unmatched), although there was no significant difference in the incidence of deep sternal wound infection (DSWI) between the two groups (zip vs. con, 0% vs. 1.1%, P=0.569), the incidence of post-operative superficial sternal wound infection (SSWI) or dehiscence was significantly higher in the con-group than in the zip-group (1.0% vs. 7.9%, P=0.013). The results were consistent in the matched patients. (DSWI: 0% vs. 0.6%, P>0.999; SSWI or dehiscence: 1.1% vs. 7.1%, P=0.036). Multivariable analysis revealed use of the zip surgical skin closure device showed a preventive effect against wound complications [odds ratio (OR): 0.128, 95% confidence interval (CI): 0.017-0.976, P=0.029].
Conclusions:
Zip surgical skin closure devices could decrease superficial wound complication rates compared to conventional suture techniques in OPCAB using BITAs.
