Clinical outcomes of a novel sternal closure technique using tension-fixed titanium cables and a biodegradable poly-lactic acid mesh plate

Sternal closure after median sternotomy is a fundamental surgical procedure in cardiovascular surgery, and inadequate fixation may result in complications such as pain, bleeding, infection and sternal dehiscence. We developed a new sternal closure technique using tension-fixed titanium cables combined with a biodegradable poly-lactic acid (PLA) mesh plate. This study aimed to evaluate the clinical effectiveness of this new technique in terms of pain reduction, sternal displacement, and postoperative recovery compared with conventional wire cerclage. A total of 250 patients who underwent median sternotomy between August 2019 and January 2025 were enrolled and categorised into two groups. Group N (n = 125) received a new technique using titanium cables and a PLA mesh plate, and Group O (n = 125) underwent conventional wire cerclage. Postoperative pain was assessed using the Numerical Rating Scale (NRS), and sternal displacement was evaluated using computed tomography. Clinical outcomes, including drainage volume, intubation time, intensive care unit (ICU)/hospital stay, and surgical site infections, were also compared. Group N had significantly lower NRS scores at 1 week (1.0 [1.0–2.0] vs. 2.0 [1.0–3.0], p = 0.02) and at discharge (1.0 [0–2.0] vs. 1.0 [1.0–2.0], p = 0.01). Transverse and longitudinal sternal displacements were significantly reduced in Group N (0.27 ± 0.71 mm vs. 0.66 ± 1.01 mm, p < 0.001; 0.51 ± 0.78 mm vs. 0.74 ± 1.07 mm, p = 0.04, respectively). Further, Group N showed lower drainage volume within 12 h postoperatively (p = 0.02), shorter time to extubation (p = 0.02), reduced ICU (p = 0.01) and hospital (p = 0.005) stay, and a lower incidence of deep sternal wound infection (0% vs. 3.2%, p = 0.04). The new sternal closure technique using tension-fixed titanium cables with a PLA mesh plate significantly improved postoperative outcomes compared with conventional wire cerclage. It effectively enhances sternal stability, reduces pain and bleeding, shortens recovery time, and lowers the risk of serious complications.