Closure Matters: Median Sternotomy Closure Using Non-Metallic Fixation Versus Conventional Steel Wires in Adult Cardiac Surgery
Creators
- 1. Northwestern University Feinberg School of Medicine Physician Assistant Program
Description
This multi-study review evaluates three studies that exam postoperative outcomes between the use of non-metallic sternal closure techniques compared with conventional stainless steel wires in adult patients undergoing median sternotomy for cardiac surgery. Stainless steel wires are largely considered the gold standard to reapproximate and close the sternum, however, they are falliable. Patients with comorbidities such as obesity, chronic obstructive pulmonary disease, diabetes, or osteoporosis are at an increased risk for postoperative complications such as sternal dehiscence or sternal wound infection, both of which can result in a secondary surgical intervention, longer hospital stays, and overall increased expenses, pain, analgesic requirements, and mortality. Over time, many alternative sternal closure devices have entered the market, however, current research has not revealed another device with superiority to wires and the decision is often guided by provider preference.
Abstract
Background: Despite the many advancements in cardiac surgery, a median sternotomy continues to be the most common surgical approach. There are numerous risks with any surgery, but for those undergoing cardiac surgery some postoperative complications include sternal wound infection and sternal dehiscence. Since 1957, surgeons have relied on stainless steel wires to close the sternum. Although sternal wires have a low complication rate, some patients are at a higher risk for postoperative complications due to risk factors like obesity, chronic obstructive pulmonary disease (COPD), and osteoporosis for example. This warrants further investigation into alternative closure methods which have become more abundant in recent years as current research has not yet shown that one technique is necessarily more effective in minimizing postoperative complications compared to stainless steel wires.
Objectives: To analyze if non-metallic sternal closure techniques, compared with conventional stainless steel wires, reduce the incidence of postoperative complications and pain in adults undergoing median sternotomy for cardiac surgery.
Design: Multi-study review
Methods: Using the National Library of Medicine’s PubMed, the Cochrane Library, and Ovid MEDLINE, a search was conducted using keywords “sternal closure” AND (“polyethylene,” “ZipFix,” “cable tie,” “polyetheretherketone,” “PEEK,” “suture tape,” OR “fiber tape”) AND (“postoperative complications” OR “postoperative infection”) to identify potential studies. Implementation of exclusion and inclusion criteria narrowed this search down to three studies analyzed for the purpose of this review.
Results:
Study #1: Statistically significant reduction in the prevalence of postoperative sternal dehiscence and pain severity reported with ZipFix device. No meaningful difference in sternal infection.
Study #2: Subset of ZipFix patients observationally showed an increase in sternal movement with no malunion across both groups. No meaningful difference with sternal infection and opioid use.
Study #3: Statistically significant decrease in the prevalence of sternal dehiscence, sternal infection, and postoperative pain and opioid use seen with the use of FiberTape and TigerTape closure technique.
Conclusion: Data collected from this review suggests that non-metallic sternal closure techniques may be beneficial in the reduction of postoperative sternal dehiscence and pain severity. However, only study #3 showed a statistically significant reduction in sternal wound infection despite the non-metallic devices having less occurrence across all studies. This suggests studies #1 and #2 are underpowered for this outcome and it would be beneficial to see if there are clinically meaningful differences with adequately powered studies in the future.
Other
The author declares no conflicts of interest.
Acknowledgements
This author would like to sincerely thank Michael A. Fotis, BS Pharm for his expertise and guidance throughout the research process.
Files
Stack, Taylor; Capstone.pdf
Files
(272.3 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:44fe1a00da87f8b3f9f705ebc75906f8
|
272.3 kB | Preview Download |
Additional details
Dates
- Submitted
-
2026-06-01
References
- Marasco SF, Fuller L, Zimmet A, et al. Prospective, randomized, controlled trial of polymer cable ties versus standard wire closure of midline sternotomy. J Thorac Cardiovasc Surg. Oct 2018;156(4):1589-1595.e1. doi:10.1016/j.jtcvs.2018.04.025
- Nezafati P, Shomali A, Kahrom M, Omidvar Tehrani S, Dianatkhah M, Nezafati MH. ZipFix Versus Conventional Sternal Closure: One-Year Follow-Up. Heart Lung Circ. Mar 2019;28(3):443-449. doi:10.1016/j.hlc.2018.01.010
- Cataneo DC, Dos Reis TA, Felisberto G, Rodrigues OR, Cataneo AJM. New sternal closure methods versus the standard closure method: systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. Mar 1 2019;28(3):432-440. doi:10.1093/icvts/ivy281
- Kumar U, Aslam U, Phillips T, Khalpey Z, Khalpey Z. Enhancing recovery and outcomes of sternal closure in cardiac surgery: Early results of a 400-patient comparison of suture tapes and steel wires. JTCVS Tech. Jun 2025;31:97-104. doi:10.1016/j.xjtc.2025.03.016
- Chopko TC, Khan FW, Stulak JM. Taken for Granted: An Analysis of Sternal Closure Techniques. Ann Thorac Surg. Jan 2026;121(1):53-64. doi:10.1016/j.athoracsur.2025.07.055
- Nooh E, Griesbach C, Rösch J, Weyand M, Harig F. Development of a new sternal dehiscence prediction scale for decision making in sternal closure techniques after cardiac surgery. J Cardiothorac Surg. Jun 14 2021;16(1):174. doi:10.1186/s13019-021-01555-2
- Farzan JJ, Furrukh AJ, Barron SL, Sjoquist JC, Bogursky A, Dunn RM. A Retrospective Application of Deep Sternal Wound Dehiscence and Malunion Risk Scores on Sternal Nonunion Patients. Plast Reconstr Surg Glob Open. Nov 2025;13(11):e7281. doi:10.1097/gox.0000000000007281
- Keating T, Tripathy A, Ivanov A, Larobina M, Skillington P. Effectiveness of Various Sternal Closure Devices Post Adult Cardiac Surgery. Heart Lung Circ. Feb 2025;34(2):135-146. doi:10.1016/j.hlc.2024.10.011
- Reifegerste CP, Moreira BL, Arakaki RA, Medeiros AK. Expected imaging findings and postoperative complications of median sternotomy. Radiol Bras. Jan-Dec 2025;58:e20240094. doi:10.1590/0100-3984.2024.0094
- Morrell Scott N, Lotto RR, Spencer E, Grant MJ, Penson P, Jones ID. Risk factors for post sternotomy wound complications across the patient journey: A systematised review of the literature. Heart Lung. Sep-Oct 2022;55:89-101. doi:10.1016/j.hrtlng.2022.04.013
- Arribas-Leal JM, Rivera-Caravaca JM, Hernández-Torres A, et al. Incidence and predictors of sternal surgical wound infection in cardiac surgery: A prospective study. Int Wound J. Apr 2023;20(4):917-924. doi:10.1111/iwj.13938
- Yost G, Marten T, Plott J, Haft JW. Practice Patterns in Sternal Closure and Evaluation of Adoption of a Novel Sternal Closure Device. Innovations (Phila). May-Jun 2024;19(3):283-289. doi:10.1177/15569845241247792
- Orhan SN, Ozyazicioglu MH, Colak A. A biomechanical study of 4 different sternum closure techniques under different deformation modes. Interact Cardiovasc Thorac Surg. Nov 1 2017;25(5):750-756. doi:10.1093/icvts/ivx175
- Stoklosa K, Munteanu D, Lachapelle K, et al. Fractured sternal wires post-coronary surgery: a cross-sectional study examining wire configurations, sternal locations, and breakage sites. Ann Thorac Surg. Feb 25 2026;doi:10.1016/j.athoracsur.2026.02.010
- Bielewicz J, Daniluk B, Kamieniak P. VAS and NRS, Same or Different? Are Visual Analog Scale Values and Numerical Rating Scale Equally Viable Tools for Assessing Patients after Microdiscectomy? Pain Res Manag. 2022;2022:5337483. doi:10.1155/2022/5337483
- Khalpey Z, Kumar UA, Aslam U, et al. Improving Sternal Closure Outcomes in Cardiac Surgery: Polyethylene Suture Tapes vs. Steel Wires. J Clin Med. Jan 6 2025;14(1)doi:10.3390/jcm14010277