Is steel wire closure of sternotomy better than polyester suture closure?
BACKGROUND
Median sternotomy is the preferred approach for open heart surgeries. The sternotomy incision is predominantly closed with either steel wire or polyester suture. The type of material used is primarily based on the surgeon's choice, and both materials achieve a good result. No prospective clinical study has been undertaken to evaluate differences in the incidence of wound infection and the degree of pain associated with both techniques.


METHODS
Our randomized controlled double-blind study included 200 adults undergoing single-valve replacement. The technique of surgery, apart from the material used for sternal closure, was the same in both groups. Postoperatively, patients were analyzed for wound infection and wound pain based on the ASEPSIS score and Numeric Pain Rating Score, respectively.


RESULTS
The polyester suture group had a significantly higher mean ASEPSIS score, indicating a higher incidence of wound infection, and more late wound complications. The polyester suture group also had a significantly higher mean pain score. The steel wire group had significantly higher mediastinal drain output in the first 48 h after surgery.


CONCLUSIONS
The use of polyester suture for sternal closure in adult patients results in increased wound infection, wound pain, and late wound complications, but lower mediastinal drain output.
Department of Cardiothoracic and Vascular Surgery, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India.
Amber
A
Malhotra
Pankaj
P
Garg
Arvind Kumar
AK
Bishnoi
Varun
V
Pendro
Pranav
P
Sharma
Madhav
M
Upadhyay
Sanjay
S
Gandhi
D000328:Adult; D001864:Bone Wires; D004311:Double-Blind Method; D004322:Drainage; D004867:Equipment Design; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007194:India; D008297:Male; D010149:Postoperative Pain / Q000209:etiology; D011091:Polyesters; D013232:Steel; D056346:Sternotomy; D013530:Surgical Wound Infection / Q000209:etiology; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation*; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation*; D055815:Young Adult
D011091:Polyesters; D013232:Steel
Pain measurement; Steel wires; Sternum; Surgical wound infection; Suture techniques; Sutures