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Sternal closure: comparison of two techniques

L Noyez¹, M W Verkroost, W N van Asten

¹Department of Thoracic and Cardiac Surgery, University Hospital Nijmegen St Radboud, The Netherlands.

Cardiovascular Surgery (London, England)

|December 1, 1993

Summary

The controlled tension osteosynthesis system for sternal closure after coronary bypass surgery did not reduce early sternal wound complications compared to stainless steel wires. Reoperations and cross-clamp time were higher with wire closure.

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Area of Science:

Cardiovascular Surgery
Thoracic Surgery
Biomedical Engineering

Background:

Sternal wound complications are a significant concern following median sternotomy.
Traditional sternal closure methods include stainless steel wires.
Novel systems like controlled tension osteosynthesis aim to improve sternal healing.

Purpose of the Study:

To compare the efficacy of controlled tension osteosynthesis versus stainless steel wires for sternal closure.
To evaluate the impact on early sternal wound complications and associated surgical outcomes.

Main Methods:

A clinical trial involving 451 patients undergoing isolated coronary bypass surgery.
Patients were divided into groups: controlled tension osteosynthesis (Groups A & C) and stainless steel wires (Group B).

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Surgical variability was reduced by having one surgeon operate on Groups A and B.

Main Results:

No significant difference in the rate or type of sternal wound complications between the two closure methods.
Group B (stainless steel wires) showed significantly more reoperations and longer cross-clamp times.
Increased use of the internal mammary artery graft was noted in Group B.

Conclusions:

Controlled tension osteosynthesis did not decrease early sternal wound complications in adult patients.
While complication rates were similar, wire closure was associated with poorer secondary outcomes.
Limitations include non-randomization and small patient numbers, warranting further investigation.