title: Reduction in deep sternal wound infection with use of a peristernal cable-tie closure system: a retrospective case series.
abstract: BACKGROUND
  Deep sternal wound infections are a rare but serious complication after median sternotomy. We evaluated the incidence of deep sternal wound infection associated with two techniques for sternal closure.
  
  
  METHODS
  In this retrospective case series, we recorded the method of sternal closure in consecutive patients undergoing a variety of cardiothoracic surgical procedures. Sternal closure in the historical control group was performed using trans-sternal, stainless-steel wire sutures; subsequent patients were closed using wire sutures in conjunction with a novel, peristernal cable-tie closure system to reinforce the corpus sterni. Perioperative care was standardized between groups. Demographics, risk factors, and postoperative outcomes were analyzed.
  
  
  RESULTS
  Between July 2010 and July 2014, 609 consecutive adult patients underwent sternal closure following open median sternotomy at a single hospital in Mobile, Alabama. Sternal closure was accomplished with wire sutures in the first 309 patients and with cable-tie reinforcement in the subsequent 300 patients. Baseline characteristics were comparable between groups, except that the cable-tie group exhibited greater preoperative comorbidity. Mean body mass index was comparable between groups (30.2 ± 6.6 kg/m(2) wire suture versus 30.5 ± 7.7 cable-tie, p = 0.568). Deep sternal wound infection occurred in 2.6 % (8/309) patients in the wire-suture group, whereas no deep sternal wound infections were observed in the cable tie group (p = 0.008).
  
  
  CONCLUSIONS
  The peristernal cable-tie system was a simple and reliable method for sternal closure after open median sternotomy, and was associated with a reduced risk of deep sternal wound infection, even in an obese and comorbid population.
authors.affiliation: Clemson University, Clemson, South Carolina, USA.
authors.forename: Meghan M
authors.initials: MM
authors.lastname: Stelly
authors.affiliation: Department of Surgery, College of Medicine and Medical Center, University of South Alabama, Mobile, Alabama, USA.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Rodning
authors.affiliation: Cardiothoracic and Vascular Surgical Associates, 1855 Springhill Avenue, Mobile, 36607, Alabama, USA. tstelly@ctvsapc.com.
authors.forename: Terry C
authors.initials: TC
authors.lastname: Stelly
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects*; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy*; D013537:Sutures; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000295:instrumentation*