[Prophylaxis of sternal dehiscence in obese patients through systematic application of Robicsek closure].
BACKGROUND
Sternal dehiscence is a relatively frequent complication in median sternotomy and causes high morbidity and mortality in cardiothoracic surgery. Obesity is one of the most important risk factors for sternal infection and dehiscence and its prevalence is increasingly frequent in patients undergoing cardiac surgery. The aim of the present study was to assess the clinical benefit of the prophylactic use of Robicsek sternal reinforcement in high-risk patients undergoing cardiac surgery.


METHODS
Two hundred ninety consecutive patients who underwent median sternotomy in our center were analyzed. The indications for prophylactic sternal reinforcement were severe sternal osteoporosis or a body mass index (BMI) of > or = 30. The technique was used in 105 patients, 54 men and 51 women, with a mean age of 67.7 +/- 9.1 years and a mean BMI of 31.8 +/- 4.1.


RESULTS
None of the patients in the reinforcement group developed noninfectious dehiscence; only one patient (1.7%) in this group showed sternal dehiscence due to osteomyelitis with good response to surgical debridement and intravenous antibiotics.


CONCLUSIONS
Robicsek reinforcement reduces the incidence of sternal dehiscence in high-risk patients and its prophylactic use should be considered in patients with severe osteoporosis or a BMI of > or = 30.
Cañas-Cañas
Alfonso
A
Servicio de Cirugía Cardíaca, Complejo Hospitalario de Toledo, Toledo, Spain. alfonso_c2@telefonica.net
Lima-Cañadas
Pedro Pablo
PP
López-Almodóvar
Luis Fernando
LF
Serrano-Martínez
Félix
F
Paredes-Astillero
Isidro
I
Torres-Crespo
María José
MJ
Muñoz-Martínez
Manuel José
MJ
Pérez-Fariña
Antonio
A
Porro-Hernández
Jesús
J
Bustos-Molina
Filadelfo
F
Calleja-Hernández
Manuel
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011446:Prospective Studies; D013249:Sternum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013536:Suture Techniques