The sternum, or breastbone, is a flat bone in the center of the chest. It forms a central part of the rib cage, protecting vital organs like the heart and lungs. This bone also serves as an attachment point for muscles and ribs, contributing to the structural integrity of the chest. To access the heart and perform procedures like bypass surgery or valve repair, surgeons must divide the sternum. This temporary separation allows direct visibility and working space for the surgical team.
Standard Wire Closure
After open-heart surgery, the most common method for rejoining the divided sternum uses stainless steel wires. This technique, known as sternal wire closure, is a standard, effective, and reliable practice. The process begins with threading several stainless steel wires through pre-drilled holes on either side of the sternal halves. These wires are strategically placed to ensure even distribution of tension across the bone. Once threaded, the wires are tightened and twisted to bring the two halves of the sternum together, creating a stable closure. The excess wire is then cut short and bent to prevent irritation to surrounding tissues. Stainless steel is chosen for these wires because of its excellent biocompatibility, meaning it is well-tolerated by the body. These wires offer substantial strength, which is essential for maintaining sternal stability during the initial healing period. This method is also chosen for its cost-effectiveness and the ability to achieve immediate rigid fixation, supporting proper bone fusion.
Alternative Closure Methods
While wire closure is prevalent, alternative methods exist for sternum closure, often considered for specific patient needs or complex cases. One alternative uses sternal plates, typically made from titanium. These plates are secured to the sternum with screws, providing a rigid fixation that can be beneficial for patients with compromised bone quality, like those with osteoporosis or a history of radiation therapy. The enhanced stability offered by plates can help reduce the risk of sternal non-union, where the bone fails to heal properly. Another option includes cable systems, which function similarly to wires but may offer broader surface contact, distributing forces more effectively. These systems can be particularly useful in re-operations where the sternal bone may be weakened from previous procedures. Other fixation devices are also employed to provide additional support in high-risk patients. The choice of an alternative method often depends on factors like the patient’s bone density, chest wall anatomy, and the surgeon’s preference, aiming to optimize healing outcomes.
Initial Post-Closure Care
Immediately following sternum closure, several steps are taken to support the patient’s recovery. A sterile dressing is applied over the surgical incision to protect the wound from infection and absorb any fluid. Drainage tubes may be placed near the sternum to collect excess blood or fluid, preventing accumulation. These tubes are typically removed within a few days when drainage subsides. Pain management begins promptly, with medications administered to alleviate discomfort associated with the sternal incision. Patients receive pain relievers to ensure comfort during the initial hours and days after surgery. The surgical team monitors the patient for signs of bleeding or swelling around the sternum, ensuring the closure remains stable. Careful positioning of the patient is maintained to avoid undue stress on the healing sternum.
Sternum Healing and Recovery
The sternum typically fuses back together over several weeks after open-heart surgery. Most patients experience significant healing within six to eight weeks, though complete fusion can take several months. Adherence to post-operative instructions is crucial for proper healing and to prevent complications. Patients should avoid activities that place excessive strain on the chest, such as heavy lifting, pushing, or pulling. Specific restrictions on arm and upper body movements protect the sternum during daily activities. For example, patients hug a pillow to their chest when coughing or sneezing to provide support. Regular, gentle walking is encouraged to promote circulation, but strenuous exercise is restricted. Persistent or worsening pain, fever, redness, swelling, or discharge from the incision site should prompt immediate medical attention, as these could indicate an infection or sternal non-union.