Adult Sternotomy Closure With Anterior, Absorbable Polydioxanone Sutures

Background: Sternal dehiscence after cardiac surgery continues to challenge reconstructive surgeons, and sternal reconstruction often requires a difficult dissection beneath the sternum to reapply metal wires for stabilization. Sternotomy closure in adults with superficial, crisscrossing absorbable sutures placed directly through the anterior ribs to secure the sternum was reviewed. Methods: Adult patients who experienced sternal dehiscence, with no bone necrosis after cardiac surgery, had their sternum repaired with absorbable polydioxanone (PDS) sutures (Ethicon, Bridgewater, NJ). Large caliber sutures (size 1 or 2 PDS) were used as multiple, “horizontal mattress” sutures placed 5–8 cm from the sternal edge directly through the anterior ribs along the length of the sternotomy. Dissection beneath the sternum was not required for suture placement. Bilateral pectoralis muscle flaps with attached rectus and external oblique fasciae were used to cover the sternal repair. This sternal closure was not used where sternal necrosis or significant bone loss was present. Results: Nine patients over a 7-year period underwent sternal repair with PDS sutures as part of their sternal reconstruction after experiencing postcardiac surgery dehiscence without bone necrosis. All patients maintained a stable sternal repair and healed without complications. No reoperations were required for these patients. Conclusions: Metal wire reapproximation of the sternum after sternal dehiscence can be difficult and hazardous. Traditional sternal rewiring can be avoided with adult sternal reconstruction using large, superficial polydioxanone sutures placed through the anterior ribs. The PDS closure technique described is a simple and reliable alternative to sternal reconstruction.