title: Sternal traction after open heart operation: an effective alternative to delayed sternal closure.
abstract: BACKGROUND
  Routine closure of the sternum after cardiovascular surgical procedures sometimes causes severe cardiac depression because of a tamponade-like reduction in ventricular filling, leading to cardiogenic shock. Leaving the sternal halves apart, sealing the mediastinum by simply approximating the skin or using a prosthetic patch, and then performing delayed sternal closure in several days is a widely practiced life-saving maneuver.
  
  
  METHODS
  Described herein is an experience with 5 patients with severe cardiac output depression of the type usually treated by delayed sternal closure. Instead, upward (outward) traction was applied to the anterior chest while the sternum was primarily closed. Traction was maintained with full-thickness chest wall sutures.
  
  
  RESULTS
  The traction sutures were removed successfully in the intensive care unit between 1 and 4 days postoperatively, after appropriate vigorous treatment of postbypass myocardial enlargement and pulmonary distention and edema.
  
  
  CONCLUSIONS
  This method of sternal traction allows physiologic improvement equivalent to delayed sternal closure in some patients and obviates the need for returning to the operating room to close the sternum in the early postoperative period.
authors.affiliation: Department of Cardiovascular Surgery, Kaiser-Permanente Medical Center, San Francisco, California, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: McEnany
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D013249:Sternum / Q000601:surgery*; D013537:Sutures; D013997:Time Factors