Sternal Reclosure Using Sternal Clips in Patients with Deep Sternal Wound Infection

Objectives: Refixation of a sternum with deep sternal wound infection is a challenging task. Due to osteomyelitis with defects in the bone and multiple fractures the usual wiring is not possible. Therefore, we used a new titanium sternal clip system for sternal closure. These clips have two or three segments. They are inserted on both sides parasternally in the intercostal space and enfold the sternum. Both length and width of the clips can be varied according to the patients’ anatomy.

Methods: We implanted the sternal clips in 21 patients (18 males). They all suffered from deep sternal wound infection after sternal split. The infection was treated by negative pressure therapy over a period of 2 to 3 weeks. In three patients the clips were implanted exclusively. In 18 patients, we used the clips to provide additional stabilization mainly of the corpus sterni. In all patients we performed a myocutaneous sliding plasty using both M. pectorales maj. to cover the wound defect.

Results: In all patients, we achieved a perfect stabilization. We could always adapt up to two clips to the sternum. In total, we implanted 12 two segment clips and 14 three segment clips. There were no major complications. In three patients there was a bleeding from a subcostal vessel, which could be treated by electric coagulation. In one patient all the osteosynthetic material displaced due to a heavy fall. Five patients developed a chronic fistula because of persistent osteomyelitis. In these patients all the osteosynthetic material was removed after eight weeks. At this point of time the osteosyntheses of the sternum was stable and there was no further need for the clips.

Conclusion: The sternal clips prove to be a safe and effective alternative to the usual wiring especially in patients with deep sternal wound infection and increase the stability of the osteosynthesis. It can be easily handled and adapted to the patients´ anatomy. Additionally, there is no need to dissect retrosternal adhesions, which may reduce the risk of injuring the heart or bypass grafts.