Sternal Closure Using Steel Wires by Figure of Eight versus Interrupted Simple Sutures in Adult Cardiac Surgeries

Abstract

edian sternotomy is one of many incisions that can be made in the thorax and gives a wide view of the thoracic cavity including cardiac structures. It also allows access to both pleural spaces, making it useful for some thoracic operations, retrosternal goiter access and esophagectomy. In addition, the incision is used for many neuro-surgical procedures that require access to thoracic vertebral bodies for treatment of neoplasms, bone cysts, osteomyelitis, and other conditions. The standard procedure for closing the sternal incision is to use wire sutures to secure the sternum. In general, two wire sutures are placed around the manubrium and four around the body of the sternum. The tissues, including the pectoralis fascia, are then closed in layers with care to close all spaces and wash out the wound thoroughly in order to try to prevent infection. However, this technique does not always produce an adequate closure of the sternum. Advances include the use of titanium plate fixation or the use of kryptonite bone cement which is a biocompatible polymer that can adhere the bone edges. Results appear promising, with a reduction in sternal displacement and improved sternal perfusion.