The Benefits of Sternal Closure Plates: A New Approach in Cardiac Surgery
Introduction
Cardiac surgery often necessitates a median sternotomy, a procedure where the sternum is divided to access the heart. Following such interventions, effective sternal closure is paramount for patient recovery and to prevent complications. Traditionally, steel wires have been the standard for sternal reapproximation. However, this method is associated with several challenges, including a risk of sternal wound infection, dehiscence, and significant postoperative pain, particularly in high-risk patient populations [1]. The emergence of sternal closure plates, often in the form of advanced suture tapes, represents a significant advancement in this field. This blog post will explore how these novel approaches offer substantial advantages over conventional methods, leading to improved patient outcomes and a reduction in post-surgical complications.
Limitations of Traditional Sternal Wire Closure
Despite its widespread use, traditional sternal wire closure presents notable limitations, especially in patients with compromised bone quality or increased mechanical stress on the sternum. High-risk groups, including obese individuals, diabetics, patients with chronic obstructive pulmonary disease (COPD), and those with osteoporosis, are particularly vulnerable to complications such as sternal wound dehiscence and infection [1]. These complications can lead to prolonged hospital stays, increased healthcare costs, and significant patient morbidity. The mechanical properties of steel wires, such as their narrow contact area, can contribute to tissue cut-through, often referred to as "cheese-wiring," and instability, further exacerbating the risk of sternal complications [1].
The Emergence of Sternal Closure Plates/Suture Tapes
Innovations in medical technology have led to the development of sternal closure plates, specifically ultrahigh-molecular-weight polyethylene suture tapes (e.g., FiberTape and TigerTape). These advanced materials offer a novel approach to sternal reapproximation. Unlike traditional wires, these suture tapes feature a flat, rectangular profile that provides a broader contact area with the sternum. This design significantly reduces the risk of tissue cut-through and preserves bone integrity, addressing a critical weakness of conventional wire closure [1]. Biomechanical studies have demonstrated the superior strength of these suture tapes, showing they can withstand nearly double the force of steel wires before failure [1]. This enhanced strength and stability contribute to a more secure sternal closure, particularly beneficial for patients with poor bone quality or those subjected to high mechanical stress.
Key Benefits and Improved Patient Outcomes
The adoption of sternal closure plates has been associated with a range of improved patient outcomes:
Reduced Complications
Studies have shown a significant reduction in sternal wound infections and dehiscence rates with the use of suture tapes compared to steel wires. For instance, one study reported sternal wound infection rates of 1% versus 5% and dehiscence rates of 0% versus 5% in favor of suture tapes [1]. These reductions are crucial for patient recovery and overall healthcare burden.
Pain Management
Postoperative pain is a major concern for patients undergoing sternotomy. Sternal closure plates have been linked to significantly less postoperative pain at both 14 and 30 days post-surgery [1]. The flatter knot stack of suture tapes, compared to sternal wire tips, reduces patient discomfort and is less noticeable on the chest wall, contributing to improved patient comfort and earlier mobilization.
Faster Recovery and Cost-Effectiveness
The enhanced stability and reduced complications associated with sternal closure plates can lead to faster patient recovery, potentially shortening hospital stays. Furthermore, the elimination of the need for sternal protection adjuncts, such as specialized chest binders or negative pressure dressings, in patients receiving suture tape closure contributes to significant cost savings. One analysis indicated savings of up to USD 102,900 for obese patients due to the reduced need for additional support devices [1]. Shorter operative times also contribute to cost reduction and decreased anesthesia exposure.
Enhanced Safety
Sternal closure plates offer enhanced safety features. In emergent situations requiring chest re-opening, suture tapes can be quickly cut with standard surgical tools, eliminating the need for specialized wire cutters and reducing the risk of damage to underlying structures. This ease of re-opening is critical in time-sensitive emergencies. Additionally, the use of suture tapes mitigates the risk of wire-stick injuries to surgical staff, an important occupational safety consideration [1].
Academic and Clinical Implications
The consistent positive outcomes observed with sternal closure plates underscore their potential to transform sternal closure practices, especially for high-risk cardiac surgery patients. The reproducibility and reliability of these systems provide a robust foundation for their broader adoption in clinical practice. While current research, such as retrospective cohort studies, provides compelling evidence, larger prospective studies and formal cost-effectiveness analyses are warranted to further optimize sternal closure strategies and solidify their long-term benefits [1].
Conclusion
Sternal closure plates represent a pivotal advancement in cardiac surgery, offering a superior alternative to traditional steel wire closure. By significantly reducing complications, alleviating postoperative pain, facilitating faster recovery, and demonstrating cost-effectiveness, these innovative systems are poised to improve patient care and outcomes dramatically. As research continues to evolve, the integration of sternal closure plates into standard surgical protocols holds immense promise for enhancing the safety and efficacy of cardiac surgical procedures.
References
[1] Khalpey, Z., Kumar, U. A., Aslam, U., Phillips, T., Khalpey, Z., Cooper, A., & Riley, R. (2025). Improving Sternal Closure Outcomes in Cardiac Surgery: Polyethylene Suture Tapes vs. Steel Wires. *J Clin Med*, *14*(1), 277. [https://pmc.ncbi.nlm.nih.gov/articles/PMC11720976/](https://pmc.ncbi.nlm.nih.gov/articles/PMC11720976/)