Sternal closure with titanium plate fixation - a paradigm shift in preventing mediastinitis

• Published in: Interactive cardiovascular and thoracic surgery 2006-08, Vol.5 (4), p.336-339
• Main Authors: Raman, Jai, Song, David H, Bolotin, Gil, Jeevanandam, Valluvan
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1510/icvts.2005.121863

a Department of Surgery, Sections of Plastic and Reconstructive Surgery, University of Chicago, MC 5040, 5841 South Maryland Ave, Chicago, IL 60637, USA b Department of Cardiothoracic Surgery, University of Chicago, USA *Corresponding author. Tel.: [phone]; fax: [phone]. E-mail address : jraman1{at}uchicago.edu (J. Raman). Sternal instability predisposes to post-operative mediastinitis. Biomechanical studies have shown the superiority of rigid plate fixation over wire circlage in sternal healing. We studied rigid plate fixation for sternotomies in high-risk patients. High-risk patients were identified as those having three or more historically established risk factors for post-operative mediastinitis, such as COPD, re-operative surgery, renal failure, diabetes, steroid use, obesity, existing infection, and immunosuppression. Three hundred and twenty high-risk patients had prophylactic rigid plate fixation (Group S) between July 2000 and Jan 2005. The control group (Group C) comprised 215 patients with similar risk profiles that were not plated during 2000 and 2001. Average age, male-female ratio, risk factors and type of procedures were similar in both groups. Follow up ranged from 4 to 200 weeks. There were 12 peri-operative deaths (3.75%) in group S and 8.6% (18 patients) in group C. There were no instances of deep mediastinitis in group S. Group C had mediastinitis in 28 (13%, P