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

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Surgical Innovation

Background:

• Sternal dehiscence is a severe complication after open heart surgery, leading to high morbidity and mortality.
• Current standard median sternotomy closure involves stainless-steel encircling wire sutures.
• Instability can result in sternal breakdown, infection, and mediastinitis.

Purpose of the Study:

• To compare the efficacy of interlocking multi-twisted sternal wire closure versus simple wire closure for median sternotomy.
• To identify the optimal sternal closure method for a standardized departmental protocol.

Main Methods:

• A prospective study of 200 adult patients undergoing cardiac surgery.
• Patients were randomized into two groups: simple wire closure (n=100) and interlocking multi-twisted wire closure (n=100).
• Outcomes assessed included sternal instability, wound infection, ventilation time, and length of stay at 7 days, 1 month, and 3 months.

Main Results:

• Sternal instability incidence was significantly higher in the simple wire group at all follow-up points (P < 0.05).
• Superficial wound infection rates were comparable between both groups.
• Intensive care unit (ICU) stay and mechanical ventilation duration showed no significant difference.

Conclusions:

• Interlocking multi-twisted sternal wire closure is a safe and effective alternative to simple wire closure.
• This method demonstrates superior performance in preventing sternal dehiscence and instability.
• The technique is easily reproducible, supporting its implementation as a standardized protocol.