A reinforced sternal wiring technique for transverse thoracosternotomy closure in bilateral lung transplantation: From biomechanical test to clinical application  Takahiro Oto, MD, PhD, Ramkumar Venkatachalam, Yos S. Morsi, PhD, Silvana Marasco, MS, FRACS, Adrian Pick, FRACS, Marc Rabinov, PhD, FRACS, Franklin Rosenfeldt, MD, FRACS  The Journal of Thoracic and Cardiovascular Surgery  Volume 134, Issue 1, Pages 218-224 (July 2007) DOI: 10.1016/j.jtcvs.2007.03.003 Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 The new reinforced wiring technique. Two peristernal stainless-steel wires are placed on the each side of the sternum at the level of the third and fifth intercostal spaces inside the conventional 2 longitudinal wires, which cross the sternotomy line. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 218-224DOI: (10.1016/j.jtcvs.2007.03.003) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 The appearance of the bone models before and after destructive testing. The parasternal wires in the reinforced wiring group prevented the longitudinal wires from cutting through the bone until the material itself parted. In contrast, failure of fixation in the conventional wiring group occurred because of the wires cutting through the bone. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 218-224DOI: (10.1016/j.jtcvs.2007.03.003) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Three biomechanical variables, including yield loading (in newtons), maximum loading (in newtons), and postyield stiffness (in newtons per millimeter), were used in this analysis. The yield load was defined as the point on the load-displacement curve at which the curve became nonlinear at the initiation of the wire cutting through the bone. The maximum load was the ultimate strength of the construct. The postyield stiffness was the slope of the load-displacement curve over a 2-mm displacement beyond the yield point. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 218-224DOI: (10.1016/j.jtcvs.2007.03.003) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Load-displacement curve of biomechanical testing. A, Longitudinal distraction. In the reinforced wiring group yield load (P = .03), maximum load (P = .03), and postyield stiffness (P = .04) were significantly greater than in the conventional wiring group. B, Anterior–posterior shear. Yield load (P = .03) and postyield stiffness (P = .04) in the reinforced wiring group were significantly greater than in the conventional wiring group. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 218-224DOI: (10.1016/j.jtcvs.2007.03.003) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions