A steel band in addition to 8 wire cerclages reduces the risk of sternal dehiscence after median sternotomy.
BACKGROUND
Sternal dehiscence after full median sternotomy may result in wound-healing disorders, including osteomyelitis. The consequences are extended hospitalization, plastic surgery, stress for the patient, and increased costs. Stable closure of the median sternotomy plays a crucial role in the avoidance of sternal dehiscence and osteomyelitis.


METHODS
All patients who underwent full sternotomy from January 1999 until December 2001 were investigated with respect to the incidence of sternal dehiscence. Since January 2000, patients supposed to be at risk for sternum dehiscence were more frequently treated with an Ethicon steel band at the third intercostal space in addition to standard osteosynthesis with 8 wire cerclages.


RESULTS
Since the introduction of this method, the incidences of sternal dehiscence and sternal wound infections decreased from 2.9% and 0.9 %, respectively, in 1999 to 0.3% and 0.2%, respectively, in 2001. This decline resulted in shorter postoperative hospital stays, less stress for the patients, and substantial reductions in postsurgical costs.


CONCLUSIONS
A steel band used in addition to standard osteosynthesis with 8 wire cerclages is a safe and effective procedure resulting in a statistically significant decrease in the frequency of sternal dehiscence.
Riess
Friedrich-Christian
FC
Department of Cardiac Surgery, Albertinen-Krankenhaus, Hamburg, Germany. Christian.Riess@albertinen.de
Awwad
Nizar
N
Hoffmann
Bettina
B
Bader
Ralf
R
Helmold
Hanns-York
HY
Loewer
Christine
C
Riess
Andreas G
AG
Bleese
Niels
N
D000368:Aged; D001864:Bone Wires; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000453:epidemiology*; D019616:Thoracic Surgical Procedures / Q000295:instrumentation* / Q000706:statistics & numerical data*