Sternal closure methods in high-risk patients: Should they be specific to the patient?

Abstract

Background: To analyze and investigate the most effective sternum closure method in high-risk patients undergoing median sternotomy, we compared a steel wire-titanium hooks combination with a steel wire-titanium plates and screws combination. Patients and Methods: We examined 67 patients who underwent median sternotomy between October 2018 and January 2020. Patients who needed postoperative chemotherapy or radiotherapy due to malignancy were excluded from the study. The patients were randomly divided into two groups with similar risk factors. In the first group, a steel wire – titanium hooks combination was used to close the sternum. A steel wire – titanium plates and screws combination was used in the second group of patients. Results: No dehiscence or mediastinitis were observed in either patient group. Superficial wound infection was seen in four patients from each group and was successfully treated with antibiotic therapy. There was no significant difference between the two groups regarding the intensive care stay, the duration of hospitalization, the amount of bleeding or the need for re-exploration (p > 0.05). Conclusion: The choice between sternal closure techniques in high-risk patients should be mainly based on the characteristics of the patient. Beyond this, the most cost-effective method in which the surgeon is most experienced should be preferred. Keywords: Titanium hooks; titanium plates and screws; tersonalized sternal closure methods