Technique for “open sternal” chest closure in patients with assist devices and transplant recipients

Commentary: Delayed sternal closure—an open and not-so-shut case

“…7 In this issue of the Journal, Balasubramanian and Bhama 8 describe a technique for DSC in which the subcutaneous tissues and skin are closed, while the sternal bone is bridged open with an orthopedic plate. Balasubramanian and Bhama 8 propose that creating a biologic tissue barrier over the mediastinum provides superior immune protection to an Esmarch and Ioban closure. In their 29-patient series, there were no cases of sternal wound or mediastinal infection.…”

“…Balasubramanian and Bhama 8 demonstrate that this approach to DSC is feasible and safe, but the impact on clinical outcomes remains unclear. The sample size is small, and there is no comparison group.…”

“…They reported SWI rates of 5% in the control group but only 2% in the intervention group, thus reducing the risk of SWI to match that of patients with primary sternal closure. 2 A randomized trial should be performed for the technique described by Balasubramanian and Bhama 8 to clarify whether a biologic barrier provides superior protection from SWI. Choice and duration of antibiotics should also be studied in a randomized fashion.…”

Commentary: Close it tight, so you can be sure it is open!

“…In this issue of the Journal , Balasubramanian and Bhama 1 describe a novel method for an old problem. How do we keep the sternum open after left ventricular assist device (LVAD) implantation or cardiac transplantation?…”

“…How do we keep the sternum open after left ventricular assist device (LVAD) implantation or cardiac transplantation? Whereas the methods used thus far have mostly been improvisations, Balasubramanian and Bhama 1 suggest a method that is not only reproducible but can also ensure a stable distance between the edges of the open sternum.…”