title: Crossed wiring closure technique for bilateral transverse thoracosternotomy is associated with less sternal dehiscence after bilateral sequential lung transplantation.
abstract: OBJECTIVE
  Bilateral transverse thoracosternotomy (clamshell incision) is a widely used approach in bilateral sequential lung transplantation, but the closure technique is associated with sternal dehiscence. This study compares the incidence of sternal dehiscence between the crossed and uncrossed closure techniques.
  
  
  METHODS
  In 129 patients who underwent transplantation through a clamshell incision, the sternum was closed using either the crossed or the uncrossed method based on the surgeon's preference. The position of the sternal parts was evaluated on lateral chest radiographs and scored as normal, override, or separation.
  
  
  RESULTS
  We observed sternal override in 38 patients and separations in 18 patients. The sternum was closed using the uncrossed method in 79 patients and the crossed method in 50 patients. There were significantly fewer overrides (n = 6, 12.0%) and separations (n = 6, 12.0%) of the sternal parts using the crossed closure technique compared with the uncrossed technique (32 overrides, 41.0%; and 12 separations, 15.1%; P < .001). Reconstructive surgery was only performed in patients with separation of the sternal parts (n = 10).
  
  
  CONCLUSIONS
  Using the crossed closure technique for the sternum after bilateral sequential lung transplantation reduces the incidence of sternal dehiscence compared with the uncrossed closure technique and, therefore, reduces the necessity of reconstructive surgery.
authors.affiliation: Department of Respiratory Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands. Electronic address: th.d.koster@gmail.com.
authors.forename: Theodoor D
authors.initials: TD
authors.lastname: Koster
authors.forename: Faiz Z
authors.initials: FZ
authors.lastname: Ramjankhan
authors.forename: Ed A
authors.initials: EA
authors.lastname: van de Graaf
authors.forename: Bart
authors.initials: B
authors.lastname: Luijk
authors.forename: Diana A
authors.initials: DA
authors.lastname: van Kessel
authors.forename: Ronald C A
authors.initials: RC
authors.lastname: Meijer
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Kwakkel-van Erp
mesh_terms: D000328:Adult; D001864:Bone Wires; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D016040:Lung Transplantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D011859:Radiography; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control*; D013908:Thoracotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation
keywords: 12; 5