Sternal weave in high-risk patients to prevent noninfective sternal dehiscence.
Dehiscence of the sternum is a serious and potentially devastating complication. The purpose of this prospective study was to determine whether a prophylactic sternal weave would decreased the incidence of noninfective sternal dehiscence, compared to routine sternal closure, in a high-risk group. Between 2000 and 2007, 200 patients undergoing median sternotomy for cardiac surgery, with one or more risk factors including New York Heart Association functional class III/IV, chronic obstructive pulmonary disease, osteoporosis, obesity, and off-midline sternotomy, were randomly assigned to group A (sternal weave closure, 100 patients) or group B (routine sternal wire closure, 100 patients). No patient in either group with a single risk factor had sternal dehiscence. The incidence of noninfective sternal dehiscence was significantly less in group A than group B in patients with 2 or more risk factors (2.5% vs. 12.5%). Routine sternal closure is sufficient in patients with a single risk factor, whereas a prophylactic sternal weave should be carried out in all patients with 2 or more risk factors, to decrease postoperative morbidity.
Narang
Sumit
S
GB Pant Hospital, Maulana Azad Medical College, New Delhi, India. sumit_narang@yahoo.com
Banerjee
Amit
A
Satsangi
Deepak K
DK
Geelani
Muhammad A
MA
D000368:Aged; D001864:Bone Wires; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome; D014945:Wound Healing