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.
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ABSTRACT: An analysis of the records of 2130 patients who consecutively underwent median sternotomy with or without cardiopulmonary bypass showed that sternal insufficiency necessitating refixation of the sternal plates developed in 12 patients (0.56%). This complication arose during the initial hospital stay in 11 patients, but in one patient the sternal instability appeared about a year after the operation. Re-exploration showed interruption of the stainless steel wires in six cases. In the other cases the wires had loosened, or knots had opened, or wires had cut through the sternal bone. All 12 patients had undergone open-heart surgery. The commonest risk factors for sternotomy dehiscence were excessive blood loss with heavy transfusion requirements, and postoperative wound infections. Other factors were respiratory complications and postoperative ventilatory support, low cardiac output syndrome, chronic obstructive pulmonary disease and obesity. Careful closure of the sternum, using figure-of-eight sutures if necessary, and avoidance of excessive application of bone wax are important for preventing this harmful complication.Scandinavian journal of thoracic and cardiovascular surgery 02/1983; 17(3):277-81.