Comparison of Sternal Fixation Strategies After Open-Heart Surgery Via a Median Sternal Incision
Jianzhou Liu1, Xiaokun Chen2, Guotao Ma1
1Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. chaojizhang@163.com.
Insights
Personalized sternal fixation and closure in open cardiac surgery reduced pain and complications. Double-wire closure showed better outcomes than single-wire fixation for median sternal incisions.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Innovation
Background:
- Median sternal incision is a common approach for open cardiac surgery.
- Sternal wound complications can significantly impact patient recovery and outcomes.
Purpose of the Study:
- To explore a personalized treatment strategy for sternal fixation and closure.
- To compare the efficacy of single-wire versus double-wire fixation for median sternal incisions.
Main Methods:
- A retrospective study of 293 patients undergoing open-heart surgery.
- Patients were divided into single-wire (control, n=169) and double-wire (study, n=124) fixation groups.
- Outcomes including pain duration, sternal instability, and wound infection were assessed over three months.
Main Results:
- The double-wire group experienced significantly shorter pain duration, reduced postoperative drainage, and lower incidences of superficial sternal wound infection and sternal instability compared to the single-wire group.
- No significant difference in deep sternal wound infection or surgery-related deaths was observed between groups.
- Baseline patient demographics were comparable between the two groups.
Conclusions:
- Personalized sternal fixation and closure strategies, tailored to patient characteristics, can minimize sternal incision complications.
- Double-wire fixation appears to be a more effective method for reducing complications in median sternal incisions.
- Further clinical studies are needed to validate the proposed personalized selection strategy.
Objectives:
To explore the personalized treatment strategy of sternal fixation and closure of sternal median incision in open cardiac surgery.
Methods:
A total of 293 patients who underwent open-heart surgery with a median sternal incision at Peking Union Medical College Hospital from January 2019 to March 2021 were divided into two groups, according to the timing and type of treatment. The first 169 patients received single-wire fixation and closure (control group), while the subsequent 124 patients received double-wire fixation and closure (study group). The patients were followed up for three months to observe the duration of pain, sternal instability, and occurrence of chest wound infection.
Results:
The average age was 53±30 years in the control group and 55±34 years in the study group (P = 0.594). There were no significant differences in baseline data between the two groups (P > 0.05). Compared with the control group, the study group had a shorter duration of pain (P < 0.05), smaller drainage volume within three days postoperatively (650 ml vs. 770 ml, P < 0.05), lower incidence of superficial sternal wound infection (2.4% vs. 8.9%, P = 0.042), and lower incidence of sternal instability (1.6% vs. 8.3%, P = 0.026). Deep sternal wound infection occurred in two patients in the control group and none in the study group; however, this difference was not significant. No surgery-related deaths occurred.
Conclusions:
Selecting the appropriate sternal fixation and closure method, according to the characteristics of patients, can reduce the incidence of sternal incision complications. We proposed a personalized selection strategy for sternal fixation and closure, which requires verification in clinical studies.
