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Ann Thorac Surg 1996;61:1585-1586
© 1996 The Society of Thoracic Surgeons

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Correspondence

Stable Osteosynthesis After Median Sternotomy

Department of Thoracic and Cardiovascular Surgery, Carolinas Heart Institute, PO Box 32861, Charlotte, NC 28232-2861

To the Editor:

Bone stability is certainly one of the most important factors in the prevention of sternum separation and deep sternal wound infection. The method presented by Drs Chlosta and Elefteriades [1] looks easier than the classic weaving-wire closure described by Robicsek and co-workers nearly two decades ago [2]. The vertical wires can certainly act like pledgets on the inner and outer tables of the sternum, but they offer less protection against lateral tearing forces, which occur at every cough. As compared with their technique the weaving method may take somewhat more time, because the rigid wires cannot be easily shaped around the ribs; however, it still offers better mechanical stability.

We agree with Dr Chlosta and Dr Elefteriades that especially in high-risk patients tight and secure sternum reapproximation-stable sternal osteosynthesis-should be done. To achieve that we frequently use one or two transsternal figure-of-8 wires as described by Goodman and associates [3]. In high-risk patients we tend to employ the technique of partial helical sternotomy [4], which allows proper reapproximation of the interfacing sternal halves (Fig 1). In cases of multiple fragmented sternum we still use the traditional sternal weave; however, in some cases we replace the parasternal wires with heavy no. 5 Ethibond sutures (Ethicon, Somerville, NJ), which are easier to handle but have adequate tensile strength. According to the surgeon's preference these techniques could be used in any combination.

View larger version (123K): [in this window] [in a new window]   Fig 1. . The corresponding sternal surfaces easily and tightly fit together after partial helical sternotomy [4]. (Illustration by Judith Kosko.)

References

1. Chlosta WF, Elefteriades JA. Simplified method of reinforced sternal closure. Ann Thorac Surg 1995;60:1428–9.[Abstract/Free Full Text]
2. Robicsek F, Daugherty HK, Cook JW. The prevention and treatment of sternum separation following open-heart surgery. J Thorac Cardiovasc Surg 1977;73:267–8.[Abstract]
3. Goodman G, Palatianos GM, Bolooki H. Technique of closure of median sternotomy with trans-sternal figure-of-eight wires. J Cardiovasc Surg 1986;27:512–3.[Medline]
4. Kollar A, Hajdu L, Sugar T. Partial helical sternotomy to promote enhanced sternal stability. J Cardiac Surg 1995;10:280.[Medline]

Reply

Section of Cardiothoracic Surgery Yale University School of Medicine 333 Cedar ST New Haven Ct 06520-8039

To the Editor:

We thank Dr Kollar and colleagues for their comments on our brief report on a ``Simplified Method of Reinforced Sternal Closure'' [1]. We have found the simplified method described in our report to provide good reinforcement of the breast bone. The theoretic concerns about the pressure against the lateral portion of the sternum were not borne out by any clinical problems in our series. In fact, in the simplified method described in our report, the vertical wires actually come to lie quite close to the lateral edge of the sternum. It appears that the good support of the inner and outer tables achieved in this way does prevent the transverse wires from tearing through. The weaving-wire closure of Robicsek and co-workers [2] is certainly the most proven method of sternal reinforcement. The additional techniques that are mentioned by Dr Kollar and colleagues, including transsternal figure-of-8 wires and partial helical sternotomy, can certainly be useful adjuncts.

References

1. Chlosta WF, Elefteriades JA. Simplified method of reinforced sternal closure. Ann Thorac Surg 1995;60:1428–9.
2. Robicsek F, Daugherty HK, Cook JW. The prevention and treatment of sternum separation following open-heart surgery. J Thorac Cardiovasc Surg 1977;73:267–8.

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kollar, A. Articles by Elefteriades, J. A. Search for Related Content PubMed PubMed Citation Articles by Kollar, A. Articles by Elefteriades, J. A.