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Ann Thorac Surg 1996;61:1586-1587
© 1996 The Society of Thoracic Surgeons

Correspondence

Simplified Reinforced Sternal Closure

Idris M. Ali, MD, Abulkasim A. Sanalla, FRCS(Ed)

Victoria General Hospital, ACC 3089, Halifax, NS B3H 2Y9, Canada
4 Lunan Pl, Leeds LS8 4ES, England

To the Editor:

We read with interest the article ``Simplified Method of Reinforced Sternal Closure'' by Chlosta and Elefteriades [1]. We believe that placing the longitudinal wire is a very good idea and definitely strengthens the closure. We have been using a similar but slightly modified technique in those patients who are at higher risk of poor sternal healing and for reclosure of sternal dehiscence with excellent results. The longitudinal wire is passed in and out through the sternal plates along the length of the sternum; the upper and the lower ends of the wire are then twisted with their partners from the other side (Fig 1Go). This modification makes the longitudinal wire more stable and works as a part of the sternum to resist the pulling-through effect of the horizontal wires. We think this is a good addition to the already described technique.




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  		Fig 1. . (A) Side view of sternum showing threading of the longitudinal wire in and out through the sternal plates. (B) Front view of sternum after approximation of both sides. The upper and lower ends of the wires of both sides are twisted together. The horizontal wires are not shown for simplification.

 

Reference

  1. Chlosta WF, Elefteriades JA. Simplified method of reinforced sternal closure. Ann Thorac Surg 1995;60:1428–9.[Abstract/Free Full Text]
 

Reply

William F. Chlosta, MD, John A. Elefteriades, MD

Section of Cardiothoracic Surgery, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06520-8039

To the Editor:

We appreciate Ali and Sanalla's comments and are pleased to note their concurrence in the importance of vertical wire reforcement. The modification of weaving the wire in and out of the sternal plates is interesting and, although slightly more complex, can be expected to contribute significantly to the strength of the sternal closure.





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