OBJECTIVE

To compare the results of sternal fixation with steel and nylon ligatures after cardiac surgery via median sternotomy.

MATERIAL AND METHODS

On-pump cardiac surgery via median sternotomy was performed in 1823 patients for the period 2009—2019. In 1225 patients, sternal osteosynthesis was performed using interrupted sutures with steel wire (group 1). In group 2 (n=598), sternal closure was carried out using continuous suture with two polyamide monofilament ligatures in 584 cases and one ligature in 14 patients. Biomechanics of sternal closure with steel and nylon ligatures studied on corpses.

RESULTS

Preoperative risk factors for wound healing were found in 50.5% of patients in the first group and 82.8% of patients in the second group. Time of sternal fixation with a wire was 17.2±5.3 min, nylon — 10.5±3.4 min. Uncomplicated wound healing was observed in 80.9% of cases (n=1096) in the first group and 96.8% of cases (n=580) in the second group. Sternal instability due to steel wire eruption was observed in 19 (1.6%) patients. Deep sternal infection developed in 14 (73.6%) of these cases. There were no cases of eruption and deep sternal infection in case of nylon ligature. In long-term period, periosteal callus was found during redo surgery in case of steel sutures (n=2) and endosteal callus (n=4) in case of nylon sutures. In the experiment, nylon sutures were evenly stretched. In case of steel wire, we found suture bending and their uneven contact with a bone.

CONCLUSION

Sternal closure with continuous elastic suture prevents contact injuries, improves fixation with a small amount of foreign material, significantly reduces the risk of deep sternal infection and time of osteosynthesis.