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Ann Thorac Surg 1996;61:1176
© 1996 The Society of Thoracic Surgeons

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Invited Commentary

Invited Commentary

Department of Surgery, St. Luke Hospital, Bethlehem, PA 18015

See also page 1172.

Over the past 15 years my colleagues and I have routinely used stainless (Parham) bands for sternal closure. Clinical results in more than 1,000 cases using such bands were previously reported. The switch to the stainless steel bands was made to avoid the complications that can be seen with the standard wire closure. Bands achieved a firm closure of the two sternal halves resulting in little or no motion of the sternal fracture. Stability of the sternal fracture results in less postoperative discomfort and increased pulmonary compliance.

There were three basic disadvantages of using the Parham bands: (1) they did not conform to the shape of the sternum, (2) there was no locking mechanism, other than the tightening device, and (3) upon reentry, they were difficult to cut. The authors of this article describe a band (the Sterna-band) that has corrected all of the basic disadvantages of the Parham band.

The first major advantage is that the material (steel) used for the Sterna-band is flexible enough to conform to the shape of the sternum. The majority of surgeons place their wires or bands around the sternum. It is useful for the wire to conform to the interspace.

The next major advantage of the Sterna-band is that it has a locking mechanism. This is used when the band is tightened around the sternum and locked into place. This has always been somewhat of a concern with the Parham band because the tightening device would strip, and the band would not be able to be tightened appropriately.

The third major advantage is that the Sterna-band is able to be cut easily upon reentry. In contrast, the Parham band was a solid stainless steel band, which was impossible to cut with standard equipment.

Another advantage of the Sterna-band is that it has a needle leading it so that it can be placed either through or around the sternum. Again, the Parham band had no needle on it and needed to be guided through using a hemostat.

I do think the Sterna-band is a unique innovation to be used to close the sternum. It would be of interest to see a large series of patients randomized using standard wires versus bands and evaluating the pulmonary compliance, use of pain medications, and postoperative stay. I do expect that the clinical experience will reveal that patients experience less pain, increased pulmonary compliance and possibly have a decreased length of stay when the sternum is securely fastened.

Related Article

Improved Sternal Closure Using Steel Bands: Early Experience With Three-Year Follow-up

Harry S Soroff, Alan R. Hartman, Eugene Pak, Dawn H Sasvary, and Stanley B Pollak
Ann. Thorac. Surg. 1996 61: 1172-1176. [Abstract] [Full Text]

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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nicholas C. Cavarocchi Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cavarocchi, N. C. Search for Related Content PubMed Articles by Cavarocchi, N. C. Related Collections Related Article