STERNAL CLOSURE USING STEEL WIRES BY FIGURE OF EIGHT VERSUS INTERRUPTED SIMPLE SUTURES IN ADULT CARDIAC SURGERIES | ||||
| Ain Shams Medical Journal | ||||
| Article 13, Volume 71, Issue 4, December 2020, Page 959-967 PDF (325.56 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/asmj.2020.148953 | ||||
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| Authors | ||||
| Faisal Amr Mourad1; Walaa Ahmed Saber Abd El Hameed1; Hossam El Din Ashour Abd El Hameed1; Mahmoud Mohamed Abu-Emma Mohamed2 | ||||
| 1Cardiothoracic Surgery Department Faculty of Medicine Ain Shams University | ||||
| 2Cardiothoracic Surgery Department Mahalla Cardiac Center. | ||||
| Abstract | ||||
| Background: Median sternotomy is a commonly performed incision with distinct advantages in adult cardiac surgeries. The stainless-steel encircling wire used as either interrupted simple sutures or as figure of eight sutures is the current standard method of median sternotomy closure. Although sternotomy closure is straight forward, it is not without complications and if not recognized early can lead to complete sternal breakdown, sternal wound infection, and mediastinitis. Aim of the Work: Comparison of the incidence of sternal stability, dehiscence and other sternal complications and the hospital stay. Patients and Methods: One hundred consecutive patients who underwent sternal closure by steel wires in adult cardiac surgeries. Intervention: closure by steel wires using either; figure of eight sutures n (50) group I or simple interrupted sutures n (50) group II in adult cardiac surgeries in a specialized health care center between January 2018 till end of January 2019. Results: Body mass index (BMI) as a risk factor between groups was statistically significant in relation to stability. 12% and 6% of patients with prolonged mechanical ventilation had sternal instability in group (I) and (II), respectively. 10 patients with prolonged ICU stay suffered sternal instability 9 were from group I and1 was from group II (P value 0.022), so the techniques of closure should be considered whenever needed for prolonged ICU stay. Regarding the instability of sternum associated with prolonged post-operative hospital stay; it was found that 50% and 23.07% in group I and II which was statistically significant in relation to instability (P value 0.0382). The overall sternal dehiscence rate was 10%; 8 cases in the in figure- of-8 sutures group and 2 in the simple interrupted sutures group. This was a statistically significant difference in rates of sternal dehiscence between the 2 groups (p 0.046). Conclusion: It is concluded that simple interrupted suturing is more effective than figure-of-8 sternal suturing in preventing sternal dehiscence. | ||||
| Keywords | ||||
| Coronary artery bypass graft; Sternotomy; Wire closure; Open heart; Mediastinitis; Sternal Wound Infection | ||||
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