Which Sternal Closure Technique is More Beneficial in Cardiac Surgery: Simple Wire, Figure-of-8, or Their Combination?

ABSTRACT

Introduction:  The aims of this study are to compare sternal closure techniques (single, figure-of-8, and combined use) in patients undergoing cardiac surgery and to investigate their relationship with postoperative sternal complications.

Method:  Between 2023 and 2024, 645 patients (470 males; mean age 58.5 ± 11.1 years) who underwent cardiac surgery were evaluated. The patients were divided into three groups: Group 1, simple wire (n = 141); Group 2, figure-of-8 (n = 224); and Group 3, combination of these two techniques (n = 280). Preoperative and perioperative data, postoperative complications, and sternal complications were compared between these groups. Result: The distribution ratio of the groups is 141 (22%), 224 (35%), and 280 (43%) in Groups 1, 2, and 3, respectively. There was no significant difference between the groups regarding basic demographic characteristics, comorbidities, and operative data. There was no difference between the groups in terms of postoperative exploration, delayed chest closure, subxiphoid decompression, superficial sternal wound infection (SSWI), deep sternal wound infection (DSWI), vacuum-assisted closure usage, intubation time, intensive care unit stay, and mortality. The hospital stay was found to be shorter in Group 3 compared to the other groups (median 8 days - 7 days, P = 0.02).

Conclusion:  In patients undergoing cardiac surgery, we found no difference in sternal complications (DSWI, SSWI) between the three most commonly used closure techniques (simple wire, figure-of-8, and their combination). We found that the length of hospital stay was shorter in patients with the combined technique than in the other two techniques.

Keywords:
Sternum; Surgical Wound Dehiscence; Wound Infection; Cardiac Surgery; Decompression.