title: Double crisscross sternal wiring and chest wound infections: a prospective randomized study.
abstract: OBJECTIVE
  We sought to assess the efficiency of 2 different sternal wiring techniques in preventing deep sternal wound infection or sternal instability.
  
  
  METHODS
  Seven hundred patients were randomized to 2 different groups according to chest-closure techniques. Three hundred fifty patients who underwent a peristernal double crisscross wire closure were included in group X, whereas 350 patients who underwent a standard transsternal closure were included in group T. After sternal closure, the technique for wound suturing was the same for both groups, namely triple-layer sutures up to the intracutaneous skin. All data were prospectively collected and entered in our institute database.
  
  
  RESULTS
  The 2 groups of patients were comparable for sex, age, preoperative risk factors, and operative procedures. The overall mortality rate was 4.3% in group X and 4.6% in group T. Postoperative morbidity and mortality were comparable between the 2 groups, unlike for sternal wound complications. None of the patients included in group X had superficial or deep wound complications, whereas in group T 7 (2%) patients presented with a superficial sternal wound infection, 6 (1.7%) presented with a deep chest wound infection with sternal instability requiring re-exploration (P <.05), and 3 presented with a sternal instability caused by sternum disruption without infection. Among patients with deep wound infection and sternal instability, 1 patient died, resulting in a mortality rate of 16.7%.
  
  
  CONCLUSIONS
  The peristernal double crisscross wiring technique achieved a greater sternal stability, resulting in a lower incidence of wound infection in association with triple-layer closure of suprasternal tissues.
authors.affiliation: Department of Cardiovascular Surgery, University of Padua Medical School, Italy. tomaso.bottio@unipd.it
authors.forename: Tomaso
authors.initials: T
authors.lastname: Bottio
authors.forename: Giulio
authors.initials: G
authors.lastname: Rizzoli
authors.forename: Vladimiro
authors.initials: V
authors.lastname: Vida
authors.forename: Dino
authors.initials: D
authors.lastname: Casarotto
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
mesh_terms: D000328:Adult; D000368:Aged; D001864:Bone Wires; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology; D013536:Suture Techniques; D013718:Tensile Strength; D013908:Thoracotomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology