title: The reinforced sternal closure system is reliable to use in elderly patients.
abstract: BACKGROUND
  Sternal dehiscence is a rare, but serious complication after cardiac surgery procedures when performed through mid-line sternotomy. Osteoporosis, especially at advanced age, may be a significant factor in the unfavorable results of sternum fixation. The present prospective, randomized study was carried out to evaluate whether the reinforced sternal-closure system is an effective and safe fixation and approximation of the sternum in cardiac procedures, and to compare with the conventional sternal-closure method in elderly patients.
  
  
  METHODS
  Forty elderly patients underwent various cardiac procedures via mid-line sternotomy under cardiopulmonary bypass. Patients were randomized into two groups: group I (n = 20) closed with the reinforced sternal-closure system, and group II (n = 20) with standard stainless steel wires. The mean age of patients in group I was 70.5 years, and group II with 70.4 years.
  
  
  RESULTS
  Superficial wound infection appeared in only one case of stapler group and in two cases of control group. Deep wound infections or dehiscence was not detected in the patients of both groups. There were no significant differences in the patient's age, drainage, pain index, time of removal of the drains, and postoperative hospital stay between the groups (p > 0.05).
  
  
  CONCLUSIONS
  The reinforced sternal-closure system provided no additional risk with similar postoperative pain index and postoperative hospital stay compared with conventional method. It is reliable to use in elderly patients undergoing open heart surgery, in the cases presenting a risk factor such as osteoporosis for increased incidence of sternal dehiscence.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Süleyman Demirel University Medical School, Isparta, Turkey. hokutan@cardio.sdu.edu.tr
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Okutan
authors.forename: Cumhur
authors.initials: C
authors.lastname: Tenekeci
authors.forename: Ali
authors.initials: A
authors.lastname: Kutsal
mesh_terms: D000367:Age Factors; D000368:Aged; D001864:Bone Wires; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D007902:Length of Stay; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013249:Sternum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology