The evidence, in full.

Prevention of sternal wound complications after sternotomy

2,539 patients undergoing cardiac surgery via median sternotomy were randomised between September 2007 and March 2010 to receive a Posthorax vest or not, worn 24 hours a day for at least six weeks, with 90-day follow-up and intention-to-treat analysis. The authors report that routine use of the device reduces the relative risk of deep sternal complications by 54%, and attribute the effect to additional stability that prevents instability and infection of the sternum while allowing deeper breathing, because friction at the sternal edges is minimised.

Gorlitzer M, Wagner F, Pfeiffer S, Folkmann S, Meinhart J, Fischlein T, Reichenspurner H, Grabenwoeger M. Interactive CardioVascular and Thoracic Surgery 2013;17(3):515–522. doi:10.1093/icvts/ivt240 · PMID 23760221

Improvement of sternum-related complications with the Posthorax support vest

1,560 cases were randomised: 905 patients received a flexible dressing postoperatively and 655 received the Posthorax support vest. Over 90 days of follow-up, additional surgical procedures were significantly reduced in the vest group. The authors conclude the vest is a valuable adjunct for preventing sternum-related complications after cardiac surgery.

Gorlitzer M, Wagner F, Pfeiffer S, Folkmann S, Meinhart J, Fischlein T, Reichenspurner H, Grabenwöger M. Interactive CardioVascular and Thoracic Surgery 2010;10(5):714–718. doi:10.1510/icvts.2009.223305

A newly designed thorax support vest prevents sternum instability after median sternotomy

The trial that introduced the device: 455 adult cardiac surgery patients were randomised postoperatively to external support with the Posthorax vest or no support, with sternal wound complications as the endpoint. Alongside the clinical result, biomechanical testing with pressure points at the thoracic wall showed a marked difference between an elastic bandage and the support vest — the basis of the anterior–posterior stabilisation argument.

Gorlitzer M, Folkmann S, Meinhart J, Poslussny P, Thalmann M, Weiss G, Bijak M, Grabenwoeger M. European Journal of Cardio-Thoracic Surgery 2009;36(2):335–339. doi:10.1016/j.ejcts.2009.01.038 · PMID 19272785

Preventing mechanical complications of median sternotomy in patients at high risk

310 patients with predisposing factors for sternal dehiscence were randomised to receive the Posthorax vest or not. Endpoints included mechanical sternal complications, quality of sternal healing, re-operation rate, length of hospitalisation and re-admission for sternal complications. The authors report that use of the vest reduces post-sternotomy mechanical complications and improves sternotomy healing, clinical course and postoperative quality of life.

Caimmi PP, Sabbatini M, Kapetanakis EI, Cantone S, Ferraz MV, Cannas M, Tesler UF. Cardiology and Therapy 2017;6(1):41–51. doi:10.1007/s40119-016-0078-y · PMID 27995554 · open access

Thorax support vests to prevent sternal wound infections — a meta-analysis

A systematic review and meta-analysis of thorax support vests in cardiac surgery pooled six randomised controlled trials covering 5,826 adult patients, including the Posthorax trials above. It is the current highest tier of evidence on the question and the right starting point for a hospital evaluating external chest support.

Caldonazo T, Dell’Aquila M, Doenst T, Gaudino M, et al. Interdisciplinary CardioVascular and Thoracic Surgery 2024;38(4):ivae055.

Karolinska University Hospital, Stockholm

In 978 patients, mediastinitis was reduced by 72% — the largest effect reported in the programme.

University Heart Center Zurich

1,689 patients: deep sternal wound infection reduced by 52%.

University Hospital Southampton NHS

265 patients: deep sternal wound infection reduced by 43%.

University Heart Center Hamburg

A cohort of 2,200 patients showed a 63% reduction in mediastinitis where the vest protocol was followed — the figure quoted by Prof. Wagner below.

Salvatore Maugeri Foundation

Across 1,009 patients, none of those wearing the vest experienced a severe complication — deep sternal wound infection or dehiscence.

SEICAV / SECTCV consensus, 2021

The Spanish consensus guidelines give a Level 2+ strong recommendation for postoperative sternal immobilisation systems in all major cardiac surgery, citing a fall in complications from 3.87% to 0.61%.⁶

Pressure-sensor testing of the thoracic wall

The 2009 trial reported biomechanical testing with pressure points at the thoracic wall, showing a marked difference between an elastic bandage and the support vest — the basis of the anterior–posterior stabilisation argument.³ The manufacturer’s own mechanical study puts numbers on it: sensors on a thorax model and 27 volunteers measured up to four times the counter-pressure of a common flexible bandage, 8 Nm against 2 Nm.

Twelve studies, none industry-funded

Twelve clinical studies covering 12,512 patients in seven countries, none funded by the manufacturer, conducted between 2010 and 2018. Study list and papers on request.