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Eur J Cardiothorac Surg 1999;15:365-369
© 1999 Elsevier Science NL

A biomechanical study of median sternotomy closure techniques¹

^a Department of Cardiothoracic Surgery, Leeds General Infirmary, Leeds LS1 3EX, UK
^b Department of Biomechanics, Clinical Sciences Building, Northern General Hospital, Sheffield S5 7AU, UK
^c Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield S5 7AU, UK

Received 20 September 1998; received in revised form 30 November 1998; accepted 22 December 1998.

Corresponding author. Tel.: +44-1482-875-875; fax: +44-1482-623-257.

Objective: Sternal dehiscence is a complication of median sternotomy incisions with high mortality and morbidity. Different techniques of sternal closure have been described. Rigid fixation of the sternum results in earlier union. We measured the rigidity of sternotomy fixation using a mechanical model in order to differentiate different techniques of sternal closure using their biomechanical characteristics. Methods: We measured the force-displacement curves of six different fixation techniques using a metal sternal model using a computerized materials-testing machine. We tested straight wires (the most commonly used surgical technique), figure-of-8 wires, `repair' technique (used when a wire breaks), Ethibond, Sterna-band and a `multitwist' closure described for the first time. Results: At 20 kg force, twisted wires used for sternotomy closures start to untwist. The most rigid closure was a multitwist closure that displaced only 0.37 mm at a force of 20 kg. Straight wires displaced 0.78 mm, figure-of-8 wires 1.20 mm, Sterna-band 1.37 mm, repair wires 5.08 mm, Ethibond 9.37 mm. The single factor Anova test for the rigidity of the different closures had P-values <0.0001. Conclusions: We applied a mathematical model to calculate chest wall forces during coughing, in order to determine the force placed upon a sternotomy closure. We conclude that severe coughing may cause wires to untwist. We discuss potential applications of different wire closures based on their characteristics.

Key Words: Sternotomy • Wires • Biomechanics

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