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J Thorac Cardiovasc Surg 2003;126:1352-1356
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Double crisscross sternal wiring and chest wound infections: A prospective randomized study

^a Department of Cardiovascular Surgery, University of Padua Medical School, Padua, Italy

Received for publication April 8, 2003; revisions received May 12, 2003; revisions received May 27, 2003; accepted for publication June 9, 2003.

^* Address for reprints: Tomaso Bottio, MD, Istituto di Cardiochirurgia, Università di Padova, Via Giustiniani 2, Padova, Italy
tomaso.bottio{at}unipd.it

OBJECTIVE: We sought to assess the efficiency of 2 different sternal wiring techniques in preventing deep sternal wound infection or sternal instability.

METHODS: Seven hundred patients were randomized to 2 different groups according to chest-closure techniques. Three hundred fifty patients who underwent a peristernal double crisscross wire closure were included in group X, whereas 350 patients who underwent a standard transsternal closure were included in group T. After sternal closure, the technique for wound suturing was the same for both groups, namely triple-layer sutures up to the intracutaneous skin. All data were prospectively collected and entered in our institute database.

RESULTS: The 2 groups of patients were comparable for sex, age, preoperative risk factors, and operative procedures. The overall mortality rate was 4.3% in group X and 4.6% in group T. Postoperative morbidity and mortality were comparable between the 2 groups, unlike for sternal wound complications. None of the patients included in group X had superficial or deep wound complications, whereas in group T 7 (2%) patients presented with a superficial sternal wound infection, 6 (1.7%) presented with a deep chest wound infection with sternal instability requiring re-exploration (P < .05), and 3 presented with a sternal instability caused by sternum disruption without infection. Among patients with deep wound infection and sternal instability, 1 patient died, resulting in a mortality rate of 16.7%.

CONCLUSIONS: The peristernal double crisscross wiring technique achieved a greater sternal stability, resulting in a lower incidence of wound infection in association with triple-layer closure of suprasternal tissues.