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Editorials

Search for a better mousetrap. The quest for an ideal method of sternal closure

^a Carolinas Heart and Vascular Institute, Carolinas Medical Center, 1001 Blythe Boulevard, Suite 300, Charlotte, NC 28203, United States
^b Heineman Medical Research Laboratory, Charlotte, NC, United States

^_* Corresponding author. Tel.: +1 704 444 3911; fax: +1 704 373 0781. (Email: francis.robicsek@carolinashealthcare.org).

The first 20% of the full text of this article appears below.

Different methods designed to re-unite the surgically divided sternum remain among the favorite subjects of professional literature. The past three decades witnessed an excess of about 20 modifications to our original parasternal ‘weaving’ technique of sternal closure [1]. Sadly most, if not all of these recommendations, were based either on clinical material which was scarce in numbers and divergent in composition, or on incomplete mechanical modeling. Some of these testing methods, for example, compare the effects of transverse forces acting on rubber hemisternums to those applied upon vertical dislocation of cadaver bones. Such methodology inevitably leads to unfounded claims and would be unacceptable even in everyday commercial product testing. It is clear that today in the era of evidence-based medicine, such a stance is no longer sustainable and we are obliged to establish acceptable standards of comparison.

At first consideration, a well-designed, prospective clinical trial would appear as the appropriate process . . . [Full Text of this Article]