Cardiothoracic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Heart Surg Forum. 2021 Apr 12;24(2):E363-E368. doi: 10.1532/hsf.3663.
Although closure of a sternotomy incision is usually a simple procedure, failure to do so (sternal dehiscence) is a serious complication and is an independent factor that poses a high degree of morbidity or mortality after open heart surgery. Instability of the bone fragments can lead to complete sternal breakdown, sternal wound infection, and mediastinitis. 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. Interlocking multi-twisted sternal wire closure is an alternative that provides rigid sternal fixation. We aim to identify the best method of sternal closure in order to implement it as a standardised protocol for our department.
Two-hundred patients aged 18-70 years were undergoing cardiac surgeries at Ain Shams University hospitals. They were divided into two groups: Group I included 100 patients with sternal closure using simple wire, and group II included 100 patients with sternal closure using interlocking multi-twisted wires. The day 7, 1 month, and 3 months sternal instability, superficial wound infection, ventilation time, cross-clamp time, length of ICU stay, and length of hospital stay were analyzed.
The incidence of sternal instability on the 7th day, 1 month, and 3 months was significantly higher in the simple wire closure group (P < 0.05). However, incidence of superficial wound infection, length of ICU stay, and duration of mechanical ventilation were comparable between the two groups.
The interlocking multi-twist is a safe, effective, and easily reproducible method for preventing sternal dehiscence.
尽管胸骨切开术切口的闭合通常是一个简单的过程，但如果不进行闭合（胸骨裂开），则是一种严重的并发症，是导致心脏直视手术后发病率或死亡率高的独立因素。骨碎片的不稳定可导致完全胸骨破裂、胸骨伤口感染和纵隔炎。作为间断单纯缝线或 8 字缝线使用的不锈钢环绕线是目前正中胸骨切开术闭合的标准方法。锁定多扭曲胸骨线闭合是一种替代方法，可提供刚性胸骨固定。我们旨在确定最佳的胸骨闭合方法，以便将其作为我们科室的标准化方案实施。
18-70 岁的 200 名患者在艾因夏姆斯大学医院接受心脏手术。他们被分为两组：第 I 组包括 100 名使用简单线缝合胸骨的患者，第 II 组包括 100 名使用锁定多扭曲线缝合胸骨的患者。分析第 7 天、第 1 个月和第 3 个月的胸骨不稳定、浅表伤口感染、通气时间、体外循环时间、重症监护病房住院时间和住院时间。
简单线缝合组胸骨不稳定的发生率在第 7 天、第 1 个月和第 3 个月显著更高（P<0.05）。然而，两组之间的浅表伤口感染发生率、重症监护病房住院时间和机械通气时间无差异。
锁定多扭曲是预防胸骨裂开的一种安全、有效且易于复制的方法。
