Use of a Sternal Support Harness to Reduce Sternal Complications: Clinicals
and Testimonials
Major complications following thoracic surgery fall into two categories: respiratory complications
and wound infections. Especially at risk are those patients with co-morbidities (i.e. diabetes, obesity,
emphysema, COPD etc) as well as barrel-chested men & large breasted women. Median sternotomy
complications occur in 0.5 to 5% of patients with 0.2 to 3% of patients developing mediastinitis (1).
The use of a sternal support harness following sternotomy has been found to reduce the incidence
of sternal complications:
“Sternal wound infections are a major cause of morbidity and mortality following cardiac surgery,
and a problem all over the world, affecting up to 5% of patients undergoing this type of operation.
The support vest reduces the number of reoperations needed due to instability and deep sternal
wound infections as well as the length of stay in hospital and is therefore cost effective due to the
reduction of major events” (2,3)
Respiratory Complications
The support, comfort and pain relief a sternum support harness offers the patients allows them to
be more confident and aggressive with deep breathing, thus contributing to increased lung volume
and a quicker recovery to pre-op respiratory levels.
Respiratory complications are a primary concern in the recovery of the post surgical patient. Deep
breathing exercises with emphasis on sustained inspiration to total lung capacity has been
constantly effective in inflating alveoli and preventing postoperative pulmonary complications (5,6).
Preoperative instruction includes the practice of proper deep breathing and coughing manoeuvres
(7). Unfortunately recovering thoracic surgical patients are frequently non-compliant during their
respiratory therapy exercise because of pain or fear of pain. Aggressive coughing and deep breathing
manoeuvres, which frequently initiate coughing, are important for purging the lungs of fluid and
inflating the lungs to prevent atelectasis. These manoeuvres are initiated in the hospital and are a
mandatory part of post discharge respiratory therapy, critical to full recovery.
Sternal Wound Stability & Sternal Wound Complications
Use of a sternal support harness has been found to cut wound infection by 50% (2). The harness
provides wound support and pain management; this in turn gives patients the confidence and
independence to continue their respiratory therapy in the unsupervised post discharge setting.
Providing patients with a sternum support harness enhances quality of care & cost containment &
provides the best possible chance of a speedy, uncomplicated recovery.
The incidence of postoperative sternal wound complications such as sternal dehiscence, infection
and sternal instability is reported as between 1 and 5% (1,8). Deep wound infection is the most
severe of the possible sternal complications and is associated with prolonged hospitalisation, high
costs and high rates of morbidity and mortality (9-12). Sternal wound complications fall into three
categories: 1) deep subcutaneous infection 2) sternal infection and 3) mediastinal infection with
sternal dehiscence. Mediastinitis occurs as a result of sternal instability and dehiscence and is usually
evident from six days to three weeks following surgery (14). Most patients are usually discharged by
this time. The incidence of morbidity and death from sternal wound complications occurs in
significant numbers of patients. Upwards of 2.3% of patients may suffer these complications with an
associated mortality rate of 13% to 52% (16, 17,18). Sternal wound infection increases the length of
hospitalisation more consistently than any other major complication (19) and significantly influences
readmission (20).
The percussive expansion associated with coughing puts extreme stress on the sternal wound.
Ambulating, getting into and out of bed or chairs, bowel movements and other normal activities also
place strain on the sternotomy site. While patients experience this stress on their sternal wound as
pain and the feeling that they are “coming apart” the clinical result may in fact be grave: dehiscence
and mediastinal infection. Sternal stability is crucial in preventing these severe sternal wound
complications. Prophylactic methods still being used to achieve sternal stability following a
sternotomy involve the use of folded sheets, towels or a pillow with hand pressure to splint the
incision (21). This method, while providing an inward pressure to the sternum, provides no encircling
support to the rib cage and chest wall during coughing is unavailable to the patient when ambulating
and provides no lateral support to stabilise the sternal wound. Without sternal support, the pain of
the surgical wound is often extreme. For this reason patients often lack the confidence to continue
with respiratory therapy exercises and coughing following discharge. The risk to these patients in the
unsupervised, post discharge setting is two-fold: 1) the patient may be unaware or unable to
diagnose a potential sternal wound complication and 2) due to pain considerations, patients often
lack the confidence to continue their respiratory therapy exercises in the outpatient setting.
References
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Gorlitzer M, et al. Prevention of Sternal Wound Complications After Sternotomy: Results of a Large Prospective
Randomised Trial. Interative Cardiovascular and Thoracic Surgery. Sep 2013; 17 (3): 515-22
Gorlitzer, M (Hospital Heitzing, Vienna, Austria) in a presentation at the European Association for Cardio-Thoracic
Surgery (EACTS) 2012 Annual Meeting
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Sarr, MG et al (1984) Mediastinal infection after cardiac surgery. Annals of Thoracic Surgery, 38, p415-423
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21. Tuyl, LJ et al. Management of Sternal precautions following median sternotomy by physical therapists in
Australia: a web-based Survey. Journal of the American Physical Therapy Association. Jan 2012; 92 (1): 83-97