Implementation of Aseptically Processed Human Placental Membrane Allografts Within a Comprehensive Sternal Wound Closure Strategy: A Three-Phase Experience

<b>Background:</b> Sternal wound complications following median sternotomy result in poor outcomes. Novel approaches such as placental allografts are being explored to optimize wound closure. <b>Methods:</b> This study evaluated consecutive patients undergoing median sternotomy by a single surgeon as sternal closure strategies evolved. Initially, wires with autologous platelet-rich plasma (PRP) were used (Group 1). Subsequently, suture tapes with PRP and an aseptically processed amnion-chorion placental allograft (aACPA) were added (Group 2). Finally, PRP was discontinued (Group 3). Sternal infection, dehiscence, pain outcomes, hospital length of stay, and patient risk factors were analyzed. <b>Results:</b> Compared to Group 1, Groups 2 and 3 demonstrated significantly lower infection (0.7%, 0% vs. 9.3%, <i>p</i> = 0.0001) and dehiscence rates (0%, 0% vs. 8.7%, <i>p</i> < 0.0001). Significant postoperative pain at two weeks decreased from Group 1 to Groups 2 and 3 (18.7%, 4.7%, 3.1%, <i>p</i> < 0.0001), with similar improvements at one month (12.0%, 2.0%, 1.5%, <i>p</i> = 0.0005). Despite higher median risk factors in Group 3 than in Groups 1 and 2 (3 vs. 2, 2, <i>p</i> = 0.0305), a trend toward reduced hospital stay was observed (6 vs. 8, 7 days, <i>p</i> = 0.2298). <b>Conclusions:</b> Adding aACPA to sternal closure significantly reduced infections, dehiscence, and pain in high-risk cardiac surgery patients, with sustained benefits and no increase in operative times. These findings highlight aACPA's potential to mitigate sternal complications, warranting further study in larger cohorts.