Sternum Dehiscence: A Preventable Complication of Median Sternotomy

Abstract

Background: The incidence of sternal dehiscence following cardiothoracic surgery via sternotomy is rare. It causes serious patient dissatisfaction and leads to higher hospital costs. For years, each clinic has made efforts to reduce this complication. Here, we aimed to summarize our techniques to prevent dehiscence. Material: This retrospective study included two groups operated via median sternotomy from March 2009 to May 2019. The first group included 1,105 consecutive patients who only received sternum wire for sternum closure from March 2009 to October 2013. The second group included 1,559 consecutive patients operated from January 2014 to May 2019; preventive closure techniques were performed for predefined high-risk patients in this group. These closure techniques included polyglyconate (Maxon) or simple longitudinal reinforced sutures, sternal cable or sternoband, sternal plate, and Robiscek technique. Results: All patients in Group 1, and 63.8% (995/1559) patients in Group 2 received sternal wire only (P < .001). In Group 2, we applied preventive closure techniques to 564 (36.2%) patients. There was no sternal dehiscence in Group 2, whereas 29 (2.6%) patients postoperatively suffered sternal dehiscence in Group 1; this was statistically significant (P = .001, OR:85.5, 95%CI:5.22-1400.4). The overall incidence of mediastinitis was 0.94%. The incidence significantly was lower in Group 2 (P = .004, OR:3.6, 95%CI:1.52-8.82). Sternum-related mortality in Group 2 also was lower (0.54% versus 0.06%, P = .048, OR:8.5, 95% CI: 1.02-70.75). Conclusion: Sternal dehiscence can be avoided by careful perioperative risk assessment and enhanced closure techniques. The same special consideration may significantly reduce mediastinitis and sternal-related mortality.

Lower Functional Status and Sternal Precaution Noncompliance May Not Be Related to Dehiscence Post-Median Sternotomy

“…Previously identified risk factors for dehiscence include chronic obstructive pulmonary disease, pneumonia, and prolonged mechanical ventilation. [2][3][4]8,10,12,[18][19][20] Our study found that the number of ventilator days was significantly greater in those with sternal aseptic osseous dehiscence than all other complication types and the matched comparator group, which affirms previous research that prolonged ventilation is a risk factor for dehiscence. Additionally, coughing has been shown to result in sternal forces substantially greater than upper extremity movements.…”

“…Given that there were no instances of documented noncompliance (ie, increased number of cues or other documented comments/concerns) in those with aseptic osseous dehiscence and no clear differences in functional status in patients with other complication types, other clinical characteristics not fully accounted for in this study may have contributed to the aseptic sternal osseous dehiscence. Previously identified risk factors for dehiscence include chronic obstructive pulmonary disease, pneumonia, and prolonged mechanical ventilation 2-4,8,10,12,18-20. Our study found that the number of ventilator days was significantly greater in those with sternal aseptic osseous dehiscence than all other complication types and the matched comparator group, which affirms previous research that prolonged ventilation is a risk factor for dehiscence.…”

“…Median sternotomy is the most common surgical incision for cardiothoracic surgical procedures. Postoperative complications range from 0.2% to 8%1-6 and can be either integumentary or osseous, and septic or aseptic. Risk factors for each have been the subject of extensive study spanning decades.…”

Using Closed Incision Negative Pressure Therapy Specialty Dressings over Incisions following Sternal Dehiscence Reconstruction

“…17 With the high burden of SSIs, attention to patient perioperative risk and the use of enhanced preventive techniques can assist in preempting the incidence of sternal instability and dehiscence. 18 In this pilot study, 16 consecutive patients with SSCs following intracardiac surgery underwent chest wall reconstruction using muscle advancement flaps followed by surgical incision management using a ciNPT specialty dressing with ciNPT over a revised median sternotomy incision. The use of ciNPT with the specialty dressing was associated with a 93.8% intact incision rate at the initial dressing change (POD 7) and at the 30-day follow-up appointment.…”

Comparison of the short and medium term efficacy of ortholox UHMWPE sternal cerclage band system and figure-of-8 wire sternum closure technique in patients at risk for sternal dehiscence

“…Age is one of the known factors associated with inadequate early healing, according to the literature(17)(18). In comparison to the Steel Wire group of the UHMWPE Cerclage Sternal Band product, the statistically significant data indicated above is determined to be successful.Obese patients had a higher risk of wound infection and sternal separation following heart surgery(19,20). Compared to the patients in the Steel Wire group, the UHMWPE Cerclage Band group's obesity levels were statistically higher.…”