Paramedian sternal bone plate reinforcement and wiring for difficult sternotomy wounds

Longitudinally oriented bone plates of stainless steel adapted to each sternal half after midline sternotomy provide a reinforced construct for transverse wiring. A method for placement of these 3.5-mm screw diameter plates in a supraperiosteal position is described. Clinical indications for use have included sternal osteoporosis, previous pull through of conventional wires, segmental sternal fractures, and obese body habitus. This technique is presented as a method to avoid sternal instability and potential wound infection for those patients at risk for sternal separation with standard wiring techniques.