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Open Access Research article

Prevention of sternal dehiscence with the Sternum External Fixation (Stern-E-Fix) corset – a randomized trial in 750 patients

Lachmandath S Tewarie*, Ares K Menon, Nima Hatam, Andrea Amerini, Ajay K Moza, Rüdiger Autschbach and Andreas Goetzenich

Author Affiliations

Department of Cardiothoracic and Vascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany

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Journal of Cardiothoracic Surgery 2012, 7:85  doi:10.1186/1749-8090-7-85

Published: 9 September 2012

Abstract

Background

The main objective of this study will be to determine the effects of a new advanced sternum external fixation (Stern-E-Fix) corset on prevention of sternal instability and mediastinitis in high-risk patients.

Methods

This prospective, randomized study (January 2009 – June 2011) comprised 750 male patients undergoing standard median sternotomy for cardiac procedures (78% CABG). Patients were divided in two randomized groups (A, n = 380: received a Stern-E-Fix corset postoperatively for 6 weeks and B, n = 370: control group received a standard elastic thorax bandage). In both groups, risk factors for sternal dehiscence and preoperative preparations were similar.

Results

Wound infections occurred in n = 13 (3.42%) pts. in group A vs. n = 35 (9.46%) in group B. In group A, only 1 patient presented with sternal dehiscence vs. 22 pts. in group B. In all 22 patients, sternal rewiring followed by antibiotic therapy was needed. Mediastinitis related mortality was none in A versus two in B. Treatment failure in group B was more than five times higher than in A (p = 0.01); the mean length of stay in hospital was 12.5 ± 7.4 days (A) versus 18 ± 15.1 days (B) (p=0.002). Re-operation for sternal infection was 4 times higher in group B. Mean ventilation time was relatively longer in B (2.5 vs. 1.28 days) (p = 0.01). The mean follow-up period was 8 weeks (range 6 – 12 weeks).

Conclusions

We demonstrated that using an external supportive sternal corset (Stern-E-Fix) yields a significantly better and effective prevention against development of sternal dehiscence and secondary sternal infection in high-risk poststernotomy patients.

Keywords:
Cardiac surgery; Sternal dehiscence; Mediastinitis; Sternum external fixation corset (Stern-E-Fix)