What question did this study set out to answer?

This research aims to assess the clinical effectiveness of a new sternal closure technique using titanium cables and a biodegradable PLA mesh plate compared to conventional methods.

April 27, 2026Open Access

Clinical outcomes of a novel sternal closure technique using tension-fixed titanium cables and a biodegradable poly-lactic acid mesh plate

THTomohide HigakiEhime University HKHirotsugu KurobeNationwide Children's Hospital HSHiroshi SakamotoEhime University

Key Points

This research aims to assess the clinical effectiveness of a new sternal closure technique using titanium cables and a biodegradable PLA mesh plate compared to conventional methods.
250 patients undergoing median sternotomy were randomly assigned to receive either the new technique or conventional wire cerclage.
Postoperative outcomes were evaluated through pain scores, computed tomography for sternal displacement, and clinical parameters like drainage volume and ICU stay.
Assessments included pain via Numerical Rating Scale, and comparisons of various clinical outcomes such as intubation time and surgical site infections.
Group N showed significantly lower pain scores at 1 week and discharge (1.0 vs 2.0, p = 0.02; 1.0 vs 1.0, p = 0.01).
Reduced sternal displacements were observed in Group N compared to Group O (0.27 mm vs. 0.66 mm, p < 0.001; 0.51 mm vs. 0.74 mm, p = 0.04).
Group N experienced lower drainage volume, shorter extubation times, reduced ICU (p = 0.01) and hospital stays (p = 0.005), and a lower incidence of deep sternal infections (0% vs 3.2%, p = 0.04).

Abstract

Sternal closure after median sternotomy is a fundamental surgical procedure in cardiovascular surgery, and inadequate fixation may result in complications such as pain, bleeding, infection and sternal dehiscence. We developed a new sternal closure technique using tension-fixed titanium cables combined with a biodegradable poly-lactic acid (PLA) mesh plate. This study aimed to evaluate the clinical effectiveness of this new technique in terms of pain reduction, sternal displacement, and postoperative recovery compared with conventional wire cerclage. A total of 250 patients who underwent median sternotomy between August 2019 and January 2025 were enrolled and categorised into two groups. Group N (n = 125) received a new technique using titanium cables and a PLA mesh plate, and Group O (n = 125) underwent conventional wire cerclage. Postoperative pain was assessed using the Numerical Rating Scale (NRS), and sternal displacement was evaluated using computed tomography. Clinical outcomes, including drainage volume, intubation time, intensive care unit (ICU)/hospital stay, and surgical site infections, were also compared. Group N had significantly lower NRS scores at 1 week (1.0 1.0–2.0 vs. 2.0 1.0–3.0, p = 0.02) and at discharge (1.0 0–2.0 vs. 1.0 1.0–2.0, p = 0.01). Transverse and longitudinal sternal displacements were significantly reduced in Group N (0.27 ± 0.71 mm vs. 0.66 ± 1.01 mm, p < 0.001; 0.51 ± 0.78 mm vs. 0.74 ± 1.07 mm, p = 0.04, respectively). Further, Group N showed lower drainage volume within 12 h postoperatively (p = 0.02), shorter time to extubation (p = 0.02), reduced ICU (p = 0.01) and hospital (p = 0.005) stay, and a lower incidence of deep sternal wound infection (0% vs. 3.2%, p = 0.04). The new sternal closure technique using tension-fixed titanium cables with a PLA mesh plate significantly improved postoperative outcomes compared with conventional wire cerclage. It effectively enhances sternal stability, reduces pain and bleeding, shortens recovery time, and lowers the risk of serious complications.

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