Figure-of-Eight vs. Interrupted Sternal Wire Closure of Median Sternotomy

Ramzisham, Abdul-Rahman Mohd; Raflis, A.; Khairul-Asri, Mohd Ghani; Min, Joanna Ooi Su; Fikri, Abdullah Mohd; Zamrin, Mohd D.

doi:10.1177/0218492309348948

Cited by 32 publications

(30 citation statements)

References 15 publications

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“…Ramzisham et al suggested that figure-of-eight sternal closure is equally effective as simple wire suturing in preventing adverse outcomes of sternal dehiscence. 10 Vular et al showed that sternal closure reinforced with rib heads technique is extremely efficient and twenty-two patients from twentythree ones whom were treated with this technique survived 11 while our study showed that figure-eight and simple technique are more related to the risk of morbidity and mortality. 11 Not accessing of association between bone healing and pain scores or complications, and not analyzing of the effect of pain severity on the activity or quality of life were limitations of our study.…”

Section: Discussionsupporting

confidence: 45%

Figure-of-Eight Wire Sternal Closure Technique Can Reduce Post-Open Cardiovascular Surgery Chest Re-Exploration and Pain Scores in Diabetic Patients with Severe Obesity (Body Mass Index: 35-40)

Mirhosseini¹

2015

IJCEMS

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Background. Postoperative sternal instability can be associated with the density of bone and type of wire closure. Sternal instability is a serious complication, especially in diabetic obese patients. This category of patients is susceptible to activation of inflammation and inflammatory and/or infective involvement of the sternum after sternotomy. This study was designed to evaluate the comparison of safety and efficacy of figure-of-eight with simple wire sternal closure technique in high-risk diabetic severe obese patients [Body mass index (BMI): 35-40]. Methods and materials. This study, conducted on 80 diabetic patients with severe obesity (BMI: 35-40) undergoing elective off-pump coronary artery bypass graft (CABG) surgery in duration from the first day to two weeks after surgery. Sternal wire closure techniques are divided into two groups, group A (n=40), patients undergoing simple wire closure and group B (n=40), patients undergoing figure-of-eight wire closure. Results. The average age of patients was 64.7±13.2 years. According to the patient self-rated numeric pain intensity scale, the pain of sternum related to existing of wire closure was classified to mild [(group A: n=14), (group B: n=17)], moderate [(group A: n=14), (group B: 19)], and severe [(group A: n=12), (group B: 4)]. Postoperative pain scores had significant higher difference in simple closure than figure-of-eight technique. From all patients, three cases with figure-of-eight and seven cases with simple wire closure had chest re-exploration after surgery. Chest re-exploration in group of figure-of-eight was lower than group of simple closure significantly (p=0.03). Postoperative utilization of inotropic agents, mediastinitis, cerebrovascular accident (CVA) and atrial fibrillation (AF) had not significant differences between both techniques. Conclusion. These findings show that figure-of-eight sternal wire closure technique can reduce postoperative pain scores and chest re-exploration significantly in diabetic patients with severe obesity.

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Section: Discussionsupporting

confidence: 45%

Figure-of-Eight Wire Sternal Closure Technique Can Reduce Post-Open Cardiovascular Surgery Chest Re-Exploration and Pain Scores in Diabetic Patients with Severe Obesity (Body Mass Index: 35-40)

Mirhosseini¹

2015

IJCEMS

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“…In human beings, median sternotomy is associated with a complication rate of 0·3 to 5% of cases and instability, non‐union and infection are common complications (Kreitmann and others 1992, Cohen and Griffin 2002, Luciani and others 2006, Ramzisham and others 2009). The use of polydioxanone has recently been validated as an alternative to wires in selected patients (infants and patients with body surface area <1·5 m 2 ) to prevent poststernotomy dehiscence (Keceligil and others 2000).…”

Section: Introductionmentioning

confidence: 99%

Mechanical comparison of median sternotomy closure in dogs using polydioxanone and wire sutures

Gines

Friend²,

Vives

et al. 2011

Journal of Small Animal Practice

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“…Most authors agree that the most important one is sternal stability after closure. 9,13,14,21 While many studies were performed to compare sternal closure methods, till now there is no ultimate method that gained the full support from all surgeons. In present study, authors compared two techniques and concluded that, regarding sternal stability, the multi-twist sternal closure showed better results than figure of eight technique despite the difference between both methods was not statistically significant mainly due to small number of patients involved in the study.…”

Section: Discussionmentioning

confidence: 99%

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

Elsaify¹,

Soltan

Soliman

et al. 2019

Int Surg J

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Background: Median sternotomy was recommended in 1957 by Julian for complete exposure of the heart. Despite the high importance of correct sternotomy, proper sternal closure is vital to ensure fewer post-operative complications. The sternum can be closed by wires and other methods. Sternal closure using the most suitable technique can dramatically reduce the risk of development of such complications.Methods: It is a prospective randomized comparative study of two patient groups, each included 30 patients, diagnosed of ischemic heart disease and underwent CABG. Group A with the patients’ sterna closed by figure of eight method and group B with multi-twist (Prakash) technique. Both groups were compared regarding postoperative pain and complications as superficial and deep sternal wound infections (SSWI, DSWI), wire removal and rewiring within six months of follow up.Results: The mean of minimum post sternotomy pain in group A patients was 24.50±11.7, whereas in patients of group B, it was 27±10.1. Only two patients (group A) suffered sternal dehiscence within six months follow up. The incidence of SSWI and DSWI among both groups was almost similar with only two patient of group A needed wire removal and one of them required rewiring.Conclusions: The multi-twist sternal closure provides better sternal stability after CABG especially in patients who are vulnerable to sternal dehiscence.

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Figure-of-Eight vs. Interrupted Sternal Wire Closure of Median Sternotomy

Cited by 32 publications

References 15 publications

Figure-of-Eight Wire Sternal Closure Technique Can Reduce Post-Open Cardiovascular Surgery Chest Re-Exploration and Pain Scores in Diabetic Patients with Severe Obesity (Body Mass Index: 35-40)

Figure-of-Eight Wire Sternal Closure Technique Can Reduce Post-Open Cardiovascular Surgery Chest Re-Exploration and Pain Scores in Diabetic Patients with Severe Obesity (Body Mass Index: 35-40)

Mechanical comparison of median sternotomy closure in dogs using polydioxanone and wire sutures

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

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