Cardiac Stab Wound Repair: Suture Selection
For repairing stab wounds to the heart, use non-absorbable polypropylene (Prolene) sutures, typically 3-0 to 5-0 size, with pledgets when needed for hemostasis in friable myocardium.
Primary Myocardial Repair Technique
The standard approach for cardiac stab wound repair involves direct suturing of the myocardial laceration:
- Non-absorbable polypropylene sutures are preferred for their strength, minimal tissue reactivity, and ability to maintain long-term wound integrity 1
- Suture size typically ranges from 3-0 to 5-0 depending on the thickness of the myocardial wall and extent of injury 1
- Pledgeted horizontal mattress or figure-of-eight sutures using 0 silk or polypropylene provide additional hemostasis when the myocardium is friable or torn 1
Alternative Emergency Techniques
In extremis situations where time is critical:
- Skin staples have been successfully used as a rapid temporizing measure for right ventricular wounds when the patient is in extremis, though this is unconventional 2
- Simple interrupted sutures can achieve adequate closure with good outcomes when performed expeditiously 3, 4
- The key is achieving immediate hemostasis rather than perfect cosmetic closure 4
Technical Considerations
Continuous versus interrupted suturing:
- Both continuous polypropylene and interrupted silk sutures have been used successfully in cardiac surgery with similar outcomes 1
- Interrupted sutures may be preferable for cardiac wounds as they allow better control of bleeding and prevent the "purse-string" effect that can occur with continuous sutures under tension 1
- The choice depends on the location, size, and configuration of the wound 3
Critical Pitfalls to Avoid
- Do not delay thoracotomy for diagnostic confirmation—all patients with suspected cardiac stab wounds should undergo immediate surgical exploration as survival is achievable even in profound shock 4
- Avoid excessive tension on sutures which can tear through friable myocardium; use pledgets liberally 1
- Do not use absorbable sutures for primary myocardial repair as the heart requires permanent structural support 1, 5
Outcome Considerations
Survival from cardiac stab wounds depends primarily on:
- Rapid surgical intervention rather than specific suture technique 4
- Simple wound closure without cardiopulmonary bypass is often sufficient for survival in patients who reach the operating room alive 3
- 53% survival rate is achievable with aggressive resuscitation and immediate thoracotomy, even in patients requiring CPR 4