A review of sternal closure techniques

Abstract

Sternotomy and sternal closure occur prior to and post cardiac surgery, respectively. Although post-operative complications associated with poor sternal fixation can result in morbidity, mortality, and considerable resource utilization, sternotomy is preferred over other methods such as lateral thoracotomy. Rigid sternal fixation is associated with stability and reduced incidence of post-operative complications. This is a comprehensive review of the literature evaluating in vivo, in vitro, and clinical responses to applying commercial and experimental surgical tools for sternal fixation after median sternotomy. Wiring, interlocking, plate-screw, and cementation techniques have been examined for closure, but none have experienced widespread adoption. Although all techniques have their advantages, serious post-operative complications were associated with the use of wiring and/or plating techniques in high-risk patients. A fraction of studies have analyzed the use of sternal interlocking systems and only a single study analyzed the effect of using kryptonite cement with wires. Plating and interlocking techniques are superior to wiring in terms of stability and reduced rate of post-operative complications; however, further clinical studies and long-term follow-up are required. The ideal sternal closure should ensure stability, reduced rate of post-operative complications, and a short hospitalization period, alongside cost-effectiveness.

A Novel Glass Polyalkenoate Cement for Fixation and Stabilisation of the Ribcage, Post Sternotomy Surgery: An ex-Vivo Study

“…However, post-operative complications such as instability, deep sternal wound infection (DSWI) and non-union are associated with poor sternal fixation resulting in mortality, morbidity and resource utilization [4,5,6,7,8,9,10,11,12,13]. Alhalawani and Towler [14] conducted a systematic review of sternal closure techniques including wiring, interlocking, plating and cementation; discussing the relative advantages and disadvantages of each. It was concluded that all of these techniques have complications restricting their widespread adoption.…”

“…Existing fixation devices for sternotomy fixation and repair have not gained widespread adoption [14]. Techniques including bands, staples, or wires are cost-effective however these fixation methods are unable to provide sufficient stabilisation, especially for patients with additional risks such as osteoporosis.…”

Minimally invasive thoracoscopically-guided right minithoracotomy versus conventional sternotomy for mitral valve repair

“…It can take up to 3 months for the sternum to heal completely (44) Minimally invasive approaches are increasingly used in all surgical specialties. They are often popular with patients, promoted by industry, and are being adopted by surgeons (73)(74)(75).…”

Prakash versus figure of eight technique in sternal closure in CABG patients

“…Simple wiring and figure of eight are performed by using four to eight stainless steel wires that can be passed directly through the sternum (transsternal technique) or through the intercostal spaces (peristernal or pericostal technique). 5,6 Multi-twist and Prakash techniques are performed through using multiple stainless-steel wires which are passed pericostally except in the manubrium where they are passed transsternally. 6,7 In Prakash technique; At least 6 wires have to be passed.…”

“…5,6 Multi-twist and Prakash techniques are performed through using multiple stainless-steel wires which are passed pericostally except in the manubrium where they are passed transsternally. 6,7 In Prakash technique; At least 6 wires have to be passed. The wires should run around the sternum in the intercostal spaces except in the manubrium where they have be passed through the bone.…”