title: A mathematical analysis of alternative sternal wound closures--an aid to reducing cardiac surgical mortality.
abstract: Sternal dehiscence is an important complication of cardiac surgery. A simple mathematical analysis is described for determining the relative strength (S) of different types of sternal closure. This is based upon resolving the tensions within the segments of a sternal wire to derive a dehiscence force. The strength of the closure (S) is the ratio of the volume of sternum which the dehiscence force acts upon to the dehiscence force itself. The derived S values varied from 4.3 for a closure using 6 transverse wires to 11.4 for a closure using the Modified Technique. The analysis suggested that closures which redistribute the transverse force to act obliquely upon a greater volume of sternum, such as the Modified Technique, are less likely to fail.
authors.affiliation: Department of Cardiothoracic Surgery, Kings College Hospital, Denmark Hill, London SE5 9RS, UK. lindsay.john@kch.nhs.uk
authors.forename: Lindsay C H
authors.initials: LC
authors.lastname: John
mesh_terms: D000818:Animals; D003198:Computer Simulation; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008954:Models, Biological; D013249:Sternum / Q000503:physiopathology* / Q000601:surgery*; D053831:Surgical Fixation Devices / Q000009:adverse effects*; D013529:Surgical Wound Dehiscence / Q000209:etiology* / Q000503:physiopathology*; D014945:Wound Healing / Q000502:physiology*