Silvana F Marasco1, Louise Fuller2, Adam Zimmet3, David McGiffin4, Michael Seitz3, Stephanie Ch'ng3, Shivanand Gangahanumaiah3, Michael Bailey5. 1. CJOB Cardiothoracic Surgery Department, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia. Electronic address: s.marasco@alfred.org.au. 2. Physiotherapy Department, The Alfred Hospital, Melbourne, Victoria, Australia. 3. CJOB Cardiothoracic Surgery Department, The Alfred Hospital, Melbourne, Victoria, Australia. 4. CJOB Cardiothoracic Surgery Department, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia. 5. Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
Abstract
OBJECTIVE:Midline sternotomy remains the most common access incision for cardiac operations. Traditionally, the sternum is closed with stainless steel wires. Wires are well known to stretch and break, however, leading to pain, nonunion, and potential deep sternal wound infection. We hypothesized that biocompatible plastic cable ties would achieve a more rigid sternal fixation, reducing postoperative pain and analgesia requirements. METHODS: A prospective, randomized study compared the ZIPFIX (De Puy Synthes, West Chester, Pa) sternal closure system (n = 58) with standard stainless steel wires (n = 60). Primary outcomes were pain and analgesia requirements in the early postoperative period. Secondary outcome was sternal movement, as assessed by ultrasound at the postoperative follow-up visit. RESULTS: Groups were well matched in demographic and operative variables. There were no significant differences between groups in postoperative pain, analgesia, or early ventilatory requirements. Patients in the ZIPFIX group had significantly more movement in the sternum and manubrium on ultrasound at 4 weeks. CONCLUSIONS:ZIPFIX sternal cable ties provide reliable closure but no demonstrable benefit in this study in pain or analgesic requirements relative to standard wire closure after median sternotomy. Crown
RCT Entities:
OBJECTIVE: Midline sternotomy remains the most common access incision for cardiac operations. Traditionally, the sternum is closed with stainless steel wires. Wires are well known to stretch and break, however, leading to pain, nonunion, and potential deep sternal wound infection. We hypothesized that biocompatible plastic cable ties would achieve a more rigid sternal fixation, reducing postoperative pain and analgesia requirements. METHODS: A prospective, randomized study compared the ZIPFIX (De Puy Synthes, West Chester, Pa) sternal closure system (n = 58) with standard stainless steel wires (n = 60). Primary outcomes were pain and analgesia requirements in the early postoperative period. Secondary outcome was sternal movement, as assessed by ultrasound at the postoperative follow-up visit. RESULTS: Groups were well matched in demographic and operative variables. There were no significant differences between groups in postoperative pain, analgesia, or early ventilatory requirements. Patients in the ZIPFIX group had significantly more movement in the sternum and manubrium on ultrasound at 4 weeks. CONCLUSIONS:ZIPFIX sternal cable ties provide reliable closure but no demonstrable benefit in this study in pain or analgesic requirements relative to standard wire closure after median sternotomy. Crown