title: Sternal closure reinforced with rib heads: a novel technique for prevention and treatment of sternal dehiscence.
abstract: BACKGROUND
  When a sternotomy cannot be performed at the midline and/or there is infection at the operation site, sternotomy revision can cause problems that increase the mortality and morbidity of the patients. There is no agreement on the best treatment method. In this paper we present a modified wiring technique.
  
  
  METHODS
  This technique consisted of wrapping wires twice around each rib head and placing standard circumferential wire sutures, thus providing full stability by decreasing the load on the sternum using only steel wires. The study group included 23 patients with sternal dehiscence because of inappropriate sternotomy (n = 10) and/or mediastinitis (n = 13). Two mediastinal tubes were placed for irrigation in 13 patients with mediastinitis and/or wound infection, and mobilization and interposition of omentum as an axial graft was performed in 2 patients. Irrigation and antibiotherapy were continued for 4 to 6 weeks.
  
  
  RESULTS
  Complete wound healing was obtained in all patients. Twenty-two patients treated with this technique survived. One patient died on postoperative 42nd day because of renal insufficiency and multi-organ failure.
  
  
  CONCLUSIONS
  Early and aggressive debridement of infected and necrotic tissue, irrigation, and antibiotics are necessary for successful treatment, but we believe that the most important factor is full stabilization of the sternal tissue with minimal use of foreign stabilization material. Despite the limited number of cases, we suggest that our stabilization technique seems to be successful in achieving full stabilization even in infected and fragile sternal bony tissue in patients with sternal dehiscence and/or inappropriate sternotomy.
authors.affiliation: Department of Cardiovascular Surgery, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey. ahvural@gmail.com
authors.forename: A Hakan
authors.initials: AH
authors.lastname: Vural
authors.forename: Serhat
authors.initials: S
authors.lastname: Yalçinkaya
authors.forename: Tamer
authors.initials: T
authors.lastname: Türk
authors.forename: Alpaslan
authors.initials: A
authors.lastname: Oztürk
authors.forename: Mustafa
authors.initials: M
authors.lastname: Sezen
authors.forename: Senol
authors.initials: S
authors.lastname: Yavuz
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ozyazicioglu
mesh_terms: D001864:Bone Wires; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003646:Debridement / Q000379:methods; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D015203:Reproducibility of Results; D013249:Sternum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013536:Suture Techniques; D007507:Therapeutic Irrigation; D016896:Treatment Outcome