Sternal Closure Techniques Using Steel Wires and Predictors of Sternal Wound Complications: A Randomized Controlled Trial.

INTRODUCTION

Median sternotomy is the gold standard for cardiac surgery but carries a significant risk of wound complications, including sternal dehiscence and wound infections.

OBJECTIVE

This study aimed to compare the early efficacy and complication rates of three distinct steel-wire sternal closure techniques and identify potential risk factors of complications.

METHODS

We conducted a randomized controlled study on patients undergoing cardiac surgery. Patients were randomly allocated into three groups of sternal closure techniques: simple interrupted (Group A), figure-of-eight (Group B), or a modified combined technique (Group C). Baseline characteristics, intraoperative parameters, postoperative recovery outcomes, and sternal wound complications including sternal dehiscence and superficial and deep wound infections were evaluated. Binomial logistic regression was performed to determine independent risk factors for complications.

RESULTS

One hundred sixty-five adult cardiac patients were finally included in the study. All three intervention groups (n = 55) were well-matched regarding baseline characteristics and intraoperative parameters. The incidence of sternal dehiscence (6.1%) and superficial (7.9%) and deep wound infections (3.6%) did not differ significantly among the three wire closure techniques (P > 0.05). However, logistic regression identified numerous factors associated with superficial sternal wound infections including old age, obesity (body mass index > 30), comorbidities, elevated C-reactive protein and HbA1C, prolonged cardiopulmonary bypass time, extended operative time, and longer intensive care unit stay (P < 0.05 for all).

CONCLUSION

The three steel-wire closure techniques demonstrated comparable early postoperative stability and similar rates of sternal wound complications. Technique choice may be based on surgeon preference.