title: Nitinol flexigrip sternal closure system and standard sternal steel wiring: insight from a matched comparative analysis.
abstract: OBJECTIVE
  We sought to assess the efficiency of two different sternal closure techniques in preventing sternal wound instability in high-risk patients.
  
  
  METHODS
  Between January 2009 and February 2012, 2068 consecutive cardiac patients were prospectively collected in our database. The 561 patients in whom the thermoreactive nitilium clips (Flexigrip) have been used (group A) were matched 1 : 1 with 561 patients who received a standard parasternal wiring technique (group B) on 10 available risk factors known to affect sternal wound healing (age, age >75 years, sex, diabetes mellitus, cardiac procedure, obesity, re-intervention, cross-clamp, and total operative times). The study was completed with a cost analysis.
  
  
  RESULTS
  The two groups were well matched, although different for bilateral internal thoracic harvesting, chronic obstructive pulmonary disease, renal insufficiency, and congestive heart failure, which were significantly more frequent in group A. At 30 days of follow-up, the association of wound complication and sternal instability was significantly less frequent in group A versus group B (0.2 versus 1.6%) (P = 0.04). Overall incidence of sternal wound complication was lower in group A (2 versus 3.5%) (P = 0.28). In the presence of wound infection, a sternal wound instability was never observed in group A (P = 0.06). Overall costs were €8,701,854 and €9,243,702 in groups A and B, respectively; thus the Flexigrip closure technique offered a €541,848 cost saving.
  
  
  CONCLUSIONS
  Flexigrip use in high-risk patients showed a lower incidence of sternal wound instability with no need for sternal re-wiring in any case, even in the presence of wound infection.
authors.affiliation: Department of Cardiac Surgery, University of Padua, Medical School of Padua, Italy.
authors.forename: Jonida
authors.initials: J
authors.lastname: Bejko
authors.forename: Tomaso
authors.initials: T
authors.lastname: Bottio
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tarzia
authors.forename: Marco
authors.initials: M
authors.lastname: De Franceschi
authors.forename: Roberto
authors.initials: R
authors.lastname: Bianco
authors.forename: Michele
authors.initials: M
authors.lastname: Gallo
authors.forename: Massimo
authors.initials: M
authors.lastname: Castoro
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bortolussi
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D001864:Bone Wires; D003324:Coronary Artery Disease / Q000191:economics / Q000601:surgery; D004867:Equipment Design; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013249:Sternum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000191:economics / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000191:economics / Q000517:prevention & control; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000191:economics / Q000295:instrumentation*
chemical_list: D000497:Alloys; C013616:nitinol