eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
Current issue Archive About the journal Supplements Abstracting and indexing Contact Instructions for authors
SCImago Journal & Country Rank

vol. 15
Original paper

Retrospective analysis of the impact of sternum closure technique on postoperative comfort and rehabilitation

Leszek Kukulski, Aleksandra Krawczyk, Jerzy Pacholewicz

Kardiochirurgia i Torakochirurgia Polska 2018; 15 (4): 233-237
Online publish date: 2018/12/31
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
Sternum closure techniques have been compared regarding biomechanics, efficacy in high-risk patients and prevention of mediastinitis or sternal dehiscence. There are no papers concerning patients’ comfort and postoperative rehabilitation rate.

To establish the best surgical closure technique after midline sternotomy regarding the lowest pain level in the postoperative period and the highest rate of postoperative rehabilitation.

Material and methods
A retrospective analysis was performed on a group of 100 patients after cardiothoracic procedures which was divided into 3 subgroups according to sternal closure technique based on postoperative thoracic X-ray. To assess patients’ pain and their physical activity we used a custom questionnaire. The statistical analysis was performed on the data regarding occurrence of wound healing complications risk factors, Numerical Rating Scale (NRS) for Pain score, the number of days until achieving important rehabilitations stages and the occurrence of sternal refixation.

Subgroups had 35, 33 and 32 patients. The statistical analysis showed significantly lower NRS scores between the 14th (p = 0.0012) (1.17) and 30th (p = 0.0196) day (0.65) after the procedure in the group sutured with only single interrupted wire. There was also a significant difference in the number of days between the operation and the first time the patient could lie sideways (p = 0.0105). There was no statistically significant difference between the three groups regarding other measured factors.

The single wire suture provides less pain at the 14th and 30th day postoperatively measured on the NRS and ensures faster rehabilitation compared to sternal closing technique which involves placing both single and figure-of-8 sutures.


median sternotomy technique, rehabilitation, pain, cardiothoracic

Julian OC, Lopez-Belio M, Dye WS, Javid H, Grove WJ. The median sternal incision in intracardiac surgery with extracorporeal circulation: a general evaluation of its use in heart surgery. Surgery 1957; 42: 753-761.
Murray KD, Pasque MK. Routine sternal closure using six overlapping figure-of-8 wires. Ann Thorac Surg 1997; 64: 1852-1854.
Tavilla G, van Son JA, Verhagen AF, Lacquet LK. Modified Robicsek technique for complicated sternal closure. Ann Thorac Surg 1991; 52: 1179-1180.
Krejca M, Szmagała P, Skarysz J, Bochenek K, Ulczok R, Bis J, Bochenek A. Force distribution in wire sternum sutures: the consequences for sternal closure rigidity. Med Sci Monit 2003; 9: BR134-44.
Losanoff JE, Collier AD, Wagner-Mann CC, Richman BW, Huff H, Hsieh Fh, Diaz-Arias A, Jones JW. Biomechanical comparison of median sternotomy closures. Ann Thorac Surg 2004; 77: 203-209.
McGregor WE, Trumble DR, Magovern JA, Robicsek F. Mechanical analysis of midline sternotomy wound closure. J Thorac Cardiovasc Surg 1999; 117: 1144-1150.
Casha AR, Yang L, Kay PH, Saleh M, Cooper GJ. A biomechanical study of median sternotomy closure techniques. Eur J Cardiothoracic Surg 1999; 15: 365-369.
Casha AR, Gauci M, Yang L, Saleh M, Kay PH, Cooper GJ. Fatigue testing median sternotomy closures q. Eur J Cardiothoracic Surg 2001; 19: 249-253.
Schimmer C, Sommer SP, Bensch M, Bohrer T, Aleksic I, Leyh R. Sternal closure techniques and postoperative sternal wound complications in elderly patients. Eur J Cardiothoracic Surg 2008; 34: 132-138.
Ramzisham ARM, Raflis AR, Khairulasri MG, Min JOS, Fikri AM, Zamrin MD. Figure-of-eight vs. interrupted sternal wire closure of median sternotomy. Asian Cardiovasc Thorac Ann 2009; 17: 587-591.
Schimmer C, Reents W, Berneder S, Eigel P, Sezer O, Scheld H, Sahraoui K, Gansera B, Deppert O, Rubio A, Feyrer R, Sauer C, Elert O, Leyh R. Prevention of sternal dehiscence and infection in high-risk patients: a prospective randomized multicenter trial. Ann Thorac Surg 2008; 86: 1897-1904.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF. Arthritis Care Res 2011; 63 (S11): S240-S252.
Cahalin PL, LaPier Kinney T, Shaw KD. Sternal precautions: is it time for change? Precautions versus restrictions – a review of literature and recommendations for revision. Cardiopulm Phys Ther J 2011; 22: 5-15.
Eisenberg E, Pultorak Y, Pud D, Bar-El Y. Prevalence and characteristics of post coronary artery bypass graft surgery pain (PCP). Pain 2001; 92: 11-17.
Tucker B, Jenkins S, Davies K, McGann R, Waddell J, King R, Kirby V, Lloyd C. The physiotherapy management of patients undergoing coronary artery surgery: a questionnaire survey. Aust J Physiother 1996; 42: 129-137.
Careaga Reyna G, Aguirre Baca GG, Medina Concebida LE, Borrayo Sanchez G, Prado Villegas G, Arguero Sanchez R. Risk factors for mediastinitis and sternal dehiscence after cardiac surgery. Rev Esp Cardiol 2006; 59: 130-135.
Lahtinen P, Kokki H, Hynynen M. Pain after cardiac surgery. Anesthesiology 2006; 105: 794-800.
Sargent LA, Seyfer AE, Hollinger J, Hinson RM, Graeber GM. The healing sternum: a comparison of osseous healing with wire versus rigid fixation. Ann Thorac Surg 1991; 52: 490-494.
Heilmann C, Stahl R, Schneider C, Sukhodolya T, Siepe M, Olschewski M, Beyersdorf F. Wound complications after median sternotomy: a single-centre study. Interact Cardiovasc Thorac Surg 2013; 16: 643-648.
Moore R, Follette DM, Berkoff HA. Poststernotomy fractures and pain management in open cardiac surgery. Chest 1994; 106: 1339-1342.
El-ansary D, Adams R, Toms L, Elkins M. Sternal instability following coronary artery bypass grafting. Theory Pract 2000; 16: 27-33.
Burckhardt CS, Anderson KL. The Quality of Life Scale (QOLS): reliability, validity, and utilization. Health Qual Life Outcomes 2003; 1: 60.
McGregor WE, Payne M, Trumble DR, Farkas KM, Magovern JA. Improvement of sternal closure stability with reinforced steel wires. Ann Thorac Surg 2003; 76: 1631-1634.
Kilian E, Mair H, Reichart B, Lamm P. Sternal closure after median sternotomy: a new technique using titanium hooks and wires applied parasternally. Interact Cardiovasc Thorac Surg 2013; 16: 721-723.
Ando T, Akiyama D, Okada H, Furukawa H, Takeda M. Novel sternum closure technique using ultra high molecular weight polyethylene sutures. Kyobu Geka 2016; 69: 1055-1058.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe