Figure-of-Eight Versus Prophylactic Sternal Weave Closure of Median Sternotomy in Diabetic Obese Patients Undergoing Coronary Artery Bypass Grafting
ABSTRACT Sternal dehiscence is a serious and potentially devastating complication after median sternotomy, especially in diabetic obese patients. The optimal technique for sternal closure is unclear in these patients.
The purpose of this prospective randomized study was to compare the incidence of sternal dehiscence after prophylactic sternal weave and figure-of-eight suturing in diabetic obese patients undergoing coronary artery bypass grafting (CABG). The patients were randomly assigned to group A (figure-of-eight closure; n=75) or group B (sternal weave closure; n=75).
There were 8 cases of sternal dehiscence documented: 7 in group A and 1 in group B. In group A, 5 patients had noninfectious sternal dehiscence and 2 patients underwent reoperation because of sternal dehiscence with mediastinitis. Also, 1 of the noninfected patients had deep-seated pain with a feeling of bony crepitus and needed reoperation. The other 4 patients in group A and 1 patient with noninfectious sternal dehiscence in group B were given chest binder support. Pain and bony crepitus decreased in the follow-up period of 1 year. Sternal dehiscence rates were 9.3% in group A and 1.3% in group B. Sternal dehiscence was significantly lower in group B (p<0.05).
Prophylactic sternal weave closure of median sternotomy reduces morbidity from sternal dehiscence in diabetic obese patients undergoing CABG.
Article: Invited commentary.The Annals of thoracic surgery 08/2011; 92(2):641. DOI:10.1016/j.athoracsur.2011.05.005 · 3.65 Impact Factor
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ABSTRACT: Objectives. Comparison of figure-of-8 wiring or simple straight-wiring technique assessed by the frequency of early noninfectious sternal dehiscence. Design. Observational register study with 7835 patients having sternal closure with figure-of-8 steel wires was compared with 2122 patients, where the sternotomy was closed by simple interrupted straight wires. The endpoint was the rate of early (within 30 days) sterile sternal dehiscence. Results. Fourteen patients (0.66%) with single wires and five patients (0.06%) with figure-of-8 wires underwent re-operation for nonmicrobial sternal disruption (p < 0.0001). The median time-point for re-intervention was 6 days for both groups. In more than 6000 patients, the sternotomy was closed with five figure-of-8 wires without dehiscence in any of them. Conclusion. In a large cohort of consecutive cardiac operations, it was found that sternal closure with figure-of-8 wires is better than closure with simple interrupted wires.Scandinavian cardiovascular journal: SCJ 01/2013; DOI:10.3109/14017431.2012.761723 · 1.10 Impact Factor
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ABSTRACT: This case report is on a obese patient who underwent a coronary artery bypass. The immediate postoperative phase, on the 8th day, was characterized by sternal dehiscence with diastasis, from intense coughing. At present, for obese patients there are not any guidelines aimed to prevent the sternal diastasis. The use of a sternum support vest after median sternotomy could be a valuable tool in the postoperative care of our patients, in order to avoid chest wall hyperexpansion and to prevent sternal wound dehiscence and diastasis.Il Giornale di chirurgia 04/2013; 34(4):112-11.