title: Primary sternal plating to prevent sternal wound complications after cardiac surgery: early experience and patterns of failure.
abstract: Sternal closure with rigid titanium plates (primary sternal plating) may reduce sternal wound complications in high-risk patients. We began performing primary sternal plating for the following indications: obesity, manual laborer, osteoporotic sternum, or intraoperative transverse sternal fracture. Patients receiving plate closure were compared to a risk-matched control group receiving wire closure. Outcomes of interest were postoperative length of stay and sternal wound complications [sterile dehiscence or deep sternal wound infection (DSWI)]. Wound complications were classified by time of occurrence as early (<or=30 days postoperation) or late (>30 days postoperation). Of 445 total cardiac cases during the 5-year study period, 129 (29%) met inclusion criteria. The plate group (n=30) and wire group (n=99) were generally well-matched in terms of risk factors. Postoperative length of stay was significantly shorter in the plate group (median 7 vs. 8 days, P=0.023). No early sternal wound complications occurred in the plate group, compared to 12 (12%) in the wire group (P=0.067). The incidence of late sternal wound complications was 10% in both groups (P=1.0). Primary sternal plating appears to provide benefits over wire closure during the early postoperative period, but may not prevent late wound complications in patients with osteoporosis or extreme obesity.
authors.affiliation: Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0016, USA. cwsnyder@uab.edu
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Snyder
authors.forename: Laura A
authors.initials: LA
authors.lastname: Graham
authors.forename: Richard E
authors.initials: RE
authors.lastname: Byers
authors.forename: William L
authors.initials: WL
authors.lastname: Holman
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D001864:Bone Wires; D006348:Cardiac Surgical Procedures; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D019637:Orthopedic Procedures / Q000295:instrumentation*; D010024:Osteoporosis / Q000150:complications; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects*; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014025:Titanium; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014025:Titanium