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Letters to the Editor

Simplified modified reinforced sternal closure

Department of Cardiac Surgery, University Hospital, Jeddah 80215, Saudi Arabia

Received 11 July 2008; accepted 22 July 2008.

^_* Corresponding author. Tel.: +966 26401000; fax: +966 26952088. (Email: dr.k-e{at}hotmail.com).

Key Words: Reinforced sternal closure • Sternum

I read with interest the article by Schimmer and co-workers [1] about sternal closure techniques and postoperative sternal wound complications in elderly patients. Initially in my practice I tried the Robiscek technique for secondary closure, post dehiscence or mediastinitis. The Robiscek is still complex and requires two extra longitudinal wires, weaving in and out through all intercostal spaces, which causes more bleeding because of multiple punctures in the sternum and surrounding tissues in addition to the extra heavy metal net. I found those patients have slow healing and considerable post healing chest wall pain, most probably due to steel irritation. Later on, I applied the primary simplified reinforced sternal closure [2] in all patients expected to have postoperative healing problems and since implementation of this concept, all sternal complications decreased dramatically. Elderly, female, osteoporotics, faulty oblique or paramedian sternotomy and improper closure are the most important factors contributing to mechanical sternal instability, which may lead to malunion, dehiscence, infection and mediastinitis. This situation becomes more complicated in tracheostomy and valve replacement patients and ends up with a major morbidity or even mortality.

This technique utilizes a single longitudinal wire on each side with only two sternal punctures at the lower and upper parts of the sternum surrounded by the conventional transverse or figure-of-eight wires. This provides a really solid and stable sternum, which is the most important prerequisite to avoid sternal complications.

I found this way of closure is simple, efficient and less traumatic to the sternum.

References

1. Schimmer C, Sommer S-P, Bensch M, Bohrer T, Aleksic I, Leyh R. Sternal closure techniques and postoperative sternal wound complications in elderly patients. Eur J Cardiothorac Surg 2008;34:132-138.[Abstract/Free Full Text]
2. Al Ebrahim K. Reinforced sternal closure: the bilateral straight longitudinal wire technique. Asian Cardiovasc Thorac Ann 2003;11:90-91.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Al Ebrahim, K. Search for Related Content PubMed Articles by Al Ebrahim, K. Related Collections Cardiac - other Related Article