Wire-Box Fixation: An Alternative Technique for Sternal Closure After Median Sternotomy in Cardiac Surgery

Background: A better sternal fixation reduces the attendant risk of superficial and deep infection and enhances postoperative respiratory mechanics, thereby fast-tracking the patient’s recovery and rehabilitation, as well as professional re-insertion. The aim of this study was to evaluate the safety and efficacy of Wire-Box Fixation as an alternative technique for sternal closure after median sternotomy. Methods: This case-series study was conducted on patients undergoing routine sternal closure after median sternotomy, which was concluded with Wire-Box Fixation. The current method can be executed with a sternal wire number 5 or 7. First, a figure-of-eight (FOE) stitch is placed on the manubrium. Then, a stitch is placed above the inferior loop of the previous one in its hole. It is thereafter exited out above the former wire and turned around downstream (interlocking) to profile the second FOE stitch so as to dress the Louis angle between the manubrium and the sternal body. This procedure is repeated until a total number of 4 to 5 interlocking FOE stitches are placed in proportion to the sternal length. When placing an FOE stitch, care should be taken to stitch perpendicularly and staying trans-sternal to decrease the risk of iatrogenic bleeding. Results: In total, 191 patients at a mean age of 56.0±14.4 years were enrolled. The mean pain score level on the first postoperative day, based on a visual analog pain scale, was reported to be 4.8±2.1, while it was reported to be 2.1±1.4 on the day of discharge. No sternum instability, dehiscence, or revision surgery was reported with the usage of Wire-Box Fixation. An incidence rate of 0.51% was reported for wound infection and 4.1% for death unrelated to wiring. No further complications were reported during a 3-month follow-up. Conclusions: It appears that Wire-Box Fixation is an optimal technique of sternal fixation given its prominent advantages of low cost, rapid installation, and low incidence of complications.