Sternal Closure After Clamshell Thoracotomy for Bilateral Lung Transplantation: Comparison Between Different...

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Transplantation Surgery

Background:

• Clamshell thoracotomy is standard for bilateral lung transplants.
• Sternal reapproximation can be challenging post-procedure.
• Optimal sternal closure is critical for patient recovery.

Purpose of the Study:

• To evaluate the effectiveness of different sternal closure techniques.
• To identify the best method for achieving proper sternal alignment post-bilateral lung transplantation.
• To correlate sternal alignment with postoperative pain.

Main Methods:

• Retrospective review of 164 bilateral lung transplant patients (2016-2023).
• Categorization by sternal closure: figure-of-eight, resorbable suture (FRS), interrupted wired sutures (IWS), and crossed wired sutures (CWS).
• Sternal alignment assessed via lateral chest X-rays (normal, override, separation).

Main Results:

• Sternal separation occurred in 18.9% of patients.
• CWS group had significantly lower separation rates (9.1%) vs. FRS (40.9%) and IWS (30.0%).
• Higher BMI increased separation risk; CWS technique reduced risk. Sternal separation correlated with higher early postoperative pain scores.

Conclusions:

• Crossed wired sutures (CWS) provide superior sternal alignment compared to other methods.
• CWS should be the preferred sternal closure technique after clamshell thoracotomy.
• Significant sternal misalignment is linked to increased early postoperative pain.