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Ann Thorac Surg 2003;76:977
© 2003 The Society of Thoracic Surgeons

Correspondence

Double criss-cross sternal wiring and chest wound infections: Reply

Hitoshi Hirose, MDa

a Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, F25/9500 Euclid Avenue, Cleveland, OH 44106 USA

e-mail: genex{at}nifty.com

To the Editor:

I thank Dr Bottio and colleagues for their comments regarding our sternal closure technique [1]. I agree with them that reapproximation of the sternum is important to prevent mediastinitis. Wiring with the figure-of-eight technique (criss-cross sternal wiring) can be used for patients with an osteoporotic sternum or a fractured sternum, and my colleagues and I have employed this method in select instances. The other technique we have used for patients at high risk for mediastinitis is sternal closure with umbilical tape. The sternum is reapproximated with both umbilical tape placed in the intercostal spaces and steel wires put directly into the sternum. Because the osteoporotic sternum is fragile and cannot hold the steel wire, tight closure with wire can cause the wire to cut through the sternum and result in postoperative sternal instability. Umbilical tape, on the other hand, is soft but strong enough to reapproximate the sternal edges. We have not encountered any problems after umbilical tape placement.

Another consideration for preventing mediastinitis is preservation of sternal blood flow. Bilateral harvest of the internal mammary artery should be avoided in patients with uncontrolled diabetes or an osteoporotic sternum. Skeletonized harvest of the internal mammary artery may be beneficial for patients undergoing bilateral internal mammary artery grafting, because the skeletonized harvest technique minimizes disturbance of sternal blood flow.

References

  1. Hirose H., Takahashi A. Sternal suturing technique and chest wound complication. Ann Thorac Surg 2002;74:634-635.[Free Full Text]




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