Closure of median sternotomy by the Sternal Talon®-system in high-risk cardiac surgical patients

Objectives: Mediastinitis is a severe complication of median sternotomy in patients at high risk for infections. The Sternal Talon®-system was developed to ensure rigid fixation of the sternum hereby preventing deep infections. The legs of the devices are inserted through the intercostal spaces, the footplates are positioned behind the sternum. The parts of the talons are closed by a ratchet-mechanism and locked by a screw. Various sizes of single or double-legged talons allow individual adaption. Three alternative methods permit re-opening.

Methods: We used the Sternal Talon-system (KLS Martin, Tuttlingen, Germany) in sixteen patients (age 69±6y, 12 females) with primary sternotomy (09/2008–08/2009). Fifteen patients were obese (body-mass-index ≥30), eleven had diabetes mellitus and six COPD. Four patients received immunosupression, one had an artificial anus.

Results: Successful placement of the talons was achieved in all patients. Four single talons were used in 7, two single and one double in five and three single in 2 cases. The other patients received one single and one double or 3 single and one double talons. We used zero or 2–5 additional wires.

No injury of thoracic vessels and no complications secondary to the device placement occurred. Postoperatively, three patients suffered from superficial infections by multiresistant staphylococci. They were successfully treated with surgical revision, negative-pressure wound-therapy and antibiotics. The sternum remained permanently stable, no mediastinitis developed. No complications were seen in the other thirteen patients.

Conclusions: The Sternal Talon-system allows stable closure of a median sternotomy and can help to prevent postoperative mediastinitis especially in patients at high risk for infections.