Figure-of-eight versus prophylactic sternal weave closure of median sternotomy in diabetic obese patients undergoing coronary artery bypass grafting.

Background: Sternal dehiscence is a serious and potentially devastating complication after median sternotomy, especially in diabetic obese patients. The optimal technique for sternal closure is unclear in these patients.

Methods: The purpose of this prospective randomized study was to compare the incidence of sternal dehiscence after prophylactic sternal weave and figure-of-eight suturing in diabetic obese patients undergoing coronary artery bypass grafting (CABG). The patients were randomly assigned to group A (figure-of-eight closure; n=75) or group B (sternal weave closure; n=75).

Results: There were 8 cases of sternal dehiscence documented: 7 in group A and 1 in group B. In group A, 5 patients had noninfectious sternal dehiscence and 2 patients underwent reoperation because of sternal dehiscence with mediastinitis. Also, 1 of the noninfected patients had deep-seated pain with a feeling of bony crepitus and needed reoperation. The other 4 patients in group A and 1 patient with noninfectious sternal dehiscence in group B were given chest binder support. Pain and bony crepitus decreased in the follow-up period of 1 year. Sternal dehiscence rates were 9.3% in group A and 1.3% in group B. Sternal dehiscence was significantly lower in group B (p<0.05).

Conclusions: Prophylactic sternal weave closure of median sternotomy reduces morbidity from sternal dehiscence in diabetic obese patients undergoing CABG.