Delayed Sternal Closure: A Successful Strategy Criticism Which Is Supported by Incomplete Data

With a reported use of 4.2%, delayed sternal closure (DSC) is considered a valuable tool in managing difficult clinical situations.During the past 2 decades, we systematically used DSC in both pediatric and adult patients with a very low incidence of bllod strem infection and related mortality. Moreover, the limitations of the conventional extemporized material (ie, syringe, tubes) used for sternal stenting (hemodynamic instability after abrupt stent removal, trauma, and so forth) were recently overtaken by the development of a new temporary sternal stenting instrument that allows “closed” remote re-approximation of the sternal halves while keeping the wound continuously covered. The device consists of stainless steel branches linked to two diverging plates of polyether ether ketone fixed to the sternal edges, the progressive opening or closing of which is controlled from outside the chest by means of a rotating steel wire passed through the skin inside a conventional chest tube drainage. Its use in the last series of patients proved safe and effective.