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Sternal plate fixation for sternal wound reconstruction: initial experience (retrospective study).

Fawzy H, Osei-Tutu K, Errett L, Latter D, Bonneau D, Musgrave M, Mahoney J - J Cardiothorac Surg (2011)

Bottom Line: Twenty two patients (55%) were diagnosed with sternal dehiscence alone and 18 patients (45%) with associated wound discharge.Sternal plating appears to be an effective option for the treatment of sternal wound dehiscence associated with sternal instability.Long-term follow-up and further larger studies are needed to address the indications, benefits and complications of sternal plating.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Terrence Donnelly Heart Center, Keenan Research Center in the Li Ka Shing Knowledge Institute of St, Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada. hosamfawzy@hotmail.com

ABSTRACT

Background: Median sternotomy infection and bony nonunion are two commonly described complications which occur in 0.4-5.1% of cardiac procedures. Although relatively infrequent, these complications can lead to significant morbidity and mortality. The aim of this retrospective study is to evaluate the initial experience of a transverse plate fixation system following wound complications associated with sternal dehiscence with or without infection following cardiac surgery.

Methods: A retrospective chart review of 40 consecutive patients who required sternal wound reconstruction post sternotomy was performed. Soft tissue debridement with removal of all compromised tissue was performed. Sternal debridement was carried using ronguers to healthy bleeding bone. All patients underwent sternal fixation using three rib plates combined with a single manubrial plate (Titanium Sternal Fixation System®, Synthes). Incisions were closed in a layered fashion with the pectoral muscles being advanced to the midline. Data were expressed as mean±SD, Median (range) or number (%). Statistical analyses were made by using Excel 2003 for Windows (Microsoft, Redmond, WA, USA).

Results: There were 40 consecutive patients, 31 males and 9 females. Twenty two patients (55%) were diagnosed with sternal dehiscence alone and 18 patients (45%) with associated wound discharge. Thirty eight patients went on to heal their wounds. Two patients developed recurrent wound infection and required VAC therapy. Both were immunocompromised. Median post-op ICU stay was one day with the median hospital stay of 18 days after plating.

Conclusion: Sternal plating appears to be an effective option for the treatment of sternal wound dehiscence associated with sternal instability. Long-term follow-up and further larger studies are needed to address the indications, benefits and complications of sternal plating.

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Related in: MedlinePlus

Post-operative Chest X-ray following sternal plates' fixation. It demonstrates sternal union.
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Figure 2: Post-operative Chest X-ray following sternal plates' fixation. It demonstrates sternal union.

Mentions: Two Jackson-Pratt no. 10 drains were placed one under each muscle flap, through two separate small incisions along the lower edge of the sternotomy wound. The muscles were approximated at the mid line with interrupted no. 1 Vicryl sutures. Superficial muscle fascia and subcutaneous tissues were closed with 2-0 Vicryl sutures. The skin was closed with staples. A postoperative chest radiograph was obtained routinely in every patient (figure 2) to confirm the position of the plates and exclude pneumothorax.


Sternal plate fixation for sternal wound reconstruction: initial experience (retrospective study).

Fawzy H, Osei-Tutu K, Errett L, Latter D, Bonneau D, Musgrave M, Mahoney J - J Cardiothorac Surg (2011)

Post-operative Chest X-ray following sternal plates' fixation. It demonstrates sternal union.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3108287&req=5

Figure 2: Post-operative Chest X-ray following sternal plates' fixation. It demonstrates sternal union.
Mentions: Two Jackson-Pratt no. 10 drains were placed one under each muscle flap, through two separate small incisions along the lower edge of the sternotomy wound. The muscles were approximated at the mid line with interrupted no. 1 Vicryl sutures. Superficial muscle fascia and subcutaneous tissues were closed with 2-0 Vicryl sutures. The skin was closed with staples. A postoperative chest radiograph was obtained routinely in every patient (figure 2) to confirm the position of the plates and exclude pneumothorax.

Bottom Line: Twenty two patients (55%) were diagnosed with sternal dehiscence alone and 18 patients (45%) with associated wound discharge.Sternal plating appears to be an effective option for the treatment of sternal wound dehiscence associated with sternal instability.Long-term follow-up and further larger studies are needed to address the indications, benefits and complications of sternal plating.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Terrence Donnelly Heart Center, Keenan Research Center in the Li Ka Shing Knowledge Institute of St, Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada. hosamfawzy@hotmail.com

ABSTRACT

Background: Median sternotomy infection and bony nonunion are two commonly described complications which occur in 0.4-5.1% of cardiac procedures. Although relatively infrequent, these complications can lead to significant morbidity and mortality. The aim of this retrospective study is to evaluate the initial experience of a transverse plate fixation system following wound complications associated with sternal dehiscence with or without infection following cardiac surgery.

Methods: A retrospective chart review of 40 consecutive patients who required sternal wound reconstruction post sternotomy was performed. Soft tissue debridement with removal of all compromised tissue was performed. Sternal debridement was carried using ronguers to healthy bleeding bone. All patients underwent sternal fixation using three rib plates combined with a single manubrial plate (Titanium Sternal Fixation System®, Synthes). Incisions were closed in a layered fashion with the pectoral muscles being advanced to the midline. Data were expressed as mean±SD, Median (range) or number (%). Statistical analyses were made by using Excel 2003 for Windows (Microsoft, Redmond, WA, USA).

Results: There were 40 consecutive patients, 31 males and 9 females. Twenty two patients (55%) were diagnosed with sternal dehiscence alone and 18 patients (45%) with associated wound discharge. Thirty eight patients went on to heal their wounds. Two patients developed recurrent wound infection and required VAC therapy. Both were immunocompromised. Median post-op ICU stay was one day with the median hospital stay of 18 days after plating.

Conclusion: Sternal plating appears to be an effective option for the treatment of sternal wound dehiscence associated with sternal instability. Long-term follow-up and further larger studies are needed to address the indications, benefits and complications of sternal plating.

Show MeSH
Related in: MedlinePlus