Negative-pressure sternal wound closure with interrupted subcuticular suturing and a subcutaneous drain tube reduces the incidence of poststernotomy wound infection after coronary artery bypass grafting surgery

  • Masahiro FujiiEmail author
  • Ryuzo Bessho
  • Yasuo Miyagi
  • Takashi Nitta
Original Article



To retrospectively evaluate the effect of negative-pressure sternal wound closure (NPSWC) with a subcutaneous closed drain tube on the sternal surgical site infection (SSI) incidence.


After propensity score matching of 231 patients undergoing coronary artery bypass grafting (CABG), we compared 104 pairs in the NPSWC and historical control groups. In the molecular analysis, the interleukin-6 (IL-6), basic fibroblast growth factor (b-FGF), and transforming growth factor β1 (TGF-β1) levels in the wound fluid were measured using two different reservoir types at postoperative days 2 and 7.


NPSWC significantly reduced the SSI incidence from 10.6 to 2.9%. No mediastinitis occurred in the NPSWC group. A multivariate logistic regression analysis identified female sex (p = 0.0040) and no NPSWC (p = 0.0084) as significant risk factors for sternal SSI development. The Negative-pressure value was 49.4 ± 4.1 and 115.5 ± 15.2 mmHg in the standard-type (SSR) and bulb-type suction reservoirs (BSR), respectively. Given that growth factors were affected by the difference in negative pressure, the IL-6, b-FGF, and TGF-β1 levels were significantly higher in the BSR than in the SSR.


NPSWC using a subcutaneous closed drain tube was effective in preventing sternal SSI after CABG and may accelerate wound healing even when both internal thoracic arteries are harvested.

Clinical registration number

University Hospital Medical Information Network Clinical Trials Registry, registration number: UMIN000037060.


Surgical site infection Coronary artery bypass surgery Negative-pressure sternal wound closure Subcutaneous closed drain tube 



The authors wish to thank Dr. Kazutora Mizukami (Ph.D. in Statistical Science, President of Medical Data Management in Fukuoka) for the statistical assistance. They would also like to thank Editage ( for the English language editing and Ethicon for permission to use the schematic illustration.


This work was supported by the Nippon Medical School Alumni Association Medical Research Grant.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest to declare.


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Masahiro Fujii
    • 1
    Email author
  • Ryuzo Bessho
    • 1
  • Yasuo Miyagi
    • 2
  • Takashi Nitta
    • 2
  1. 1.Cardiavascular SurgeryNippon Medical School Chiba Hokusoh HospitalInzaiJapan
  2. 2.Cardiavascular SurgeryNippon Medical SchoolTokyoJapan

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