Primary sternal plating to prevent sternal wound complications after cardiac surgery: early experience and patterns of failure

• Published in: Interactive cardiovascular and thoracic surgery Vol. 9; no. 5; pp. 763 - 766
• Main Authors: Snyder, Christopher W, Graham, Laura A, Byers, Richard E, Holman, William L
• Format: Journal Article
• Language: English
• Published: England Eur Assoc Cardio Surg 01-11-2009
• Subjects: Adult; Aged; Bone Plates; Bone Wires; Cardiac Surgical Procedures; Case-Control Studies; Female; Humans; Length of Stay; Male; Mediastinitis - diagnostic imaging; Mediastinitis - etiology; Mediastinitis - prevention & control; Middle Aged; Obesity - complications; Orthopedic Procedures - instrumentation; Osteoporosis - complications; Prosthesis Design; Prosthesis Failure; Reoperation; Risk Factors; Sternotomy - adverse effects; Surgical Wound Dehiscence - diagnostic imaging; Surgical Wound Dehiscence - etiology; Surgical Wound Dehiscence - prevention & control; Surgical Wound Infection - diagnostic imaging; Surgical Wound Infection - etiology; Surgical Wound Infection - prevention & control; Time Factors; Titanium; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1510/icvts.2009.214023

a Department of Surgery, University of Alabama at Birmingham, 1922 7th Avenue South, KB 217, Birmingham, AL 35294-0016, USA
b Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
c Center for Surgical, Medical Acute Care and Transitions, Birmingham, AL, USA
d Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
*Corresponding author. Tel.: [phone]; fax: [phone]. E-mail address : cwsnyder{at}uab.edu (C.W. Snyder).
Sternal closure with rigid titanium plates (primary sternal plating) may reduce sternal wound complications in high-risk patients. We began performing primary sternal plating for the following indications: obesity, manual laborer, osteoporotic sternum, or intraoperative transverse sternal fracture. Patients receiving plate closure were compared to a risk-matched control group receiving wire closure. Outcomes of interest were postoperative length of stay and sternal wound complications [sterile dehiscence or deep sternal wound infection (DSWI)]. Wound complications were classified by time of occurrence as early ( 30 days postoperation) or late (>30 days postoperation). Of 445 total cardiac cases during the 5-year study period, 129 (29%) met inclusion criteria. The plate group ( n =30) and wire group ( n =99) were generally well-matched in terms of risk factors. Postoperative length of stay was significantly shorter in the plate group (median 7 vs. 8 days, P =0.023). No early sternal wound complications occurred in the plate group, compared to 12 (12%) in the wire group ( P =0.067). The incidence of late sternal wound complications was 10% in both groups ( P =1.0). Primary sternal plating appears to provide benefits over wire closure during the early postoperative period, but may not prevent late wound complications in patients with osteoporosis or extreme obesity.
Key Words: Sternal dehiscence; Mediastinitis; Sternal plating