title: Primary closure of median sternotomy: a survey of all German surgical heart centers and a review of the literature concerning sternal closure technique.
abstract: BACKGROUND
  Sternal instability and mediastinitis are rare but serious complications following cardiac surgery with median sternotomy.
  
  
  METHODS
  This study presents the results of a questionnaire, which was sent to all 79 German surgical heart centers. The conventional sternal closure technique, the parameters considered to be risk factors for sternal instability, and the surgical strategy in the presence of risk factors were determined. In addition, a literature research with the key words "sternal closure technique" and "sternal dehiscence" was performed.
  
  
  RESULTS
  Conventional closure of primary sternotomy is done using many different methods, most often with surgical steel sutures (87 %) passed trans/peristernally (64 %). An osteoporotic or fractured sternum (70 x), and obesity (31 x) were the most frequently cited risk factors. The preferred osteosynthetic procedure for patients with an increased risk for sternal instability was the method of Robicsek (48 x).
  
  
  CONCLUSIONS
  There is no uniform osteosynthetic method for primary sternal closure and there is substantial variation in the perception of risk factors for sternal instability and possible surgical consequences among the surgical heart centers in Germany.
authors.affiliation: Zentrum Operative Medizin, Klinik und Poliklinik für Herz-, und Thoraxchirurgie der Universität Würzburg, Würzburg, Germany. schimmer_c@klinik.uni-wuerzburg.de
authors.forename: C
authors.initials: C
authors.lastname: Schimmer
authors.forename: W
authors.initials: W
authors.lastname: Reents
authors.forename: O
authors.initials: O
authors.lastname: Elert
mesh_terms: D001696:Biomechanical Phenomena; D002300:Cardiac Care Facilities; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005858:Germany; D019538:Health Care Surveys; D006801:Humans; D008480:Mediastinitis / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D053831:Surgical Fixation Devices; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013536:Suture Techniques