Early Sternal Bone Healing after Thermoreactive Nitinol Flexigrip Sternal Closure

Area of Science:

• Thoracic surgery
• Biomaterials engineering
• Orthopedic surgery

Background:

• Conventional sternal closure often utilizes wire fixation.
• Ensuring optimal sternal bone healing is crucial for patient recovery after median sternotomy.
• Nitinol-based devices offer potential advantages in orthopedic fixation.

Purpose of the Study:

• To compare the efficacy of thermoreactive nitinol Flexigrip versus conventional wire closure for sternal fixation.
• To evaluate early sternal bone healing using computed tomography (CT) in patients undergoing sternal closure.

Main Methods:

• A prospective cohort study compared 80 patients with wire closure to 44 patients with Flexigrip sternal closure.
• Sternal healing was quantitatively assessed via CT scans on postoperative day 14, measuring gaps and offsets at six sternal levels.
• Secondary outcomes included pain scores and sternal complications at one month post-surgery.

Main Results:

• Flexigrip closure showed significantly fewer sternal gaps (52% vs. 70%) and offsets (3.3 mm vs. 4.3 mm) at the manubrium compared to wiring (p=0.04 and p<0.001, respectively).
• Reduced gaps (25% vs. 43%) and offsets (2.3% vs. 24%) were also observed at the mid-sternum with Flexigrip (p=0.04 and p=0.002, respectively).
• No significant differences in pain scores or sternal complication rates were found between the two groups.

Conclusions:

• Computed tomography evaluation at two weeks post-surgery indicated superior sternal bone union with Flexigrip closure compared to conventional wiring.
• Flexigrip sternal closure resulted in less sternal dehiscence, suggesting enhanced early bone healing.
• The nitinol-based Flexigrip device may offer an advantage over traditional wiring for sternal closure.