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Titanium plate fixation for sternal dehiscence in major cardiac surgery.

Kim WK, Kim JB, Kim GS, Jung SH, Choo SJ, Chung CH, Lee JW - Korean J Thorac Cardiovasc Surg (2013)

Bottom Line: Two patients required additional soft tissue wound revisions.Another patient presented with a tuberculous wound infection which was resolved using anti-tuberculosis medications.The postoperative course was uncomplicated in the other 13 patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea.

ABSTRACT

Background: Sternal dehiscence is one of the most troublesome complications following cardiac surgery. Treatment failure and consequent lethal outcomes are very common. The aim of this study was to evaluate titanium plate fixation as a treatment for sternal dehiscence following major cardiac surgery.

Materials and methods: Between 2010 and 2012, 17 patients underwent sternal reconstruction using horizontal titanium plating for the treatment of post-cardiac-surgery sternal dehiscence. The plates were cut and shaped, and then were fixed to corresponding costal segments using 2-3 titanium screws per each side.

Results: The median age of our patients was 66 years (range, 50 to 78 years) and 9 were female. Indications for sternal reconstruction included aseptic sternal dehiscence in 3 patients and osteomyelitis in 14 patients including 6 patients who were diagnosed with mediastinitis. During the operation, sternal resection and autologous flap interposition were combined in 11 patients. One patient died due to sepsis. Two patients required additional soft tissue wound revisions. Another patient presented with a tuberculous wound infection which was resolved using anti-tuberculosis medications. The postoperative course was uncomplicated in the other 13 patients.

Conclusion: Titanium plate fixation that combines appropriate debridement and flap interposition is very effective for the treatment of sternal dehiscence following major cardiac surgery.

No MeSH data available.


Related in: MedlinePlus

Fixation of transverse titanium plates for dehisced sternum (patient #1). (A) Intra-operative findings of sternal dehiscence with purulent discharge which are indicative of sternal osteomyelitis (following aortic valve replacement and coronary artery bypass). (B) Horizontal fixation of the titanium plates was performed on the same patient. Two drainage catheters were placed under the pectoralis muscle layer. (C) Postoperative simple chest radiograph.
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Figure 1: Fixation of transverse titanium plates for dehisced sternum (patient #1). (A) Intra-operative findings of sternal dehiscence with purulent discharge which are indicative of sternal osteomyelitis (following aortic valve replacement and coronary artery bypass). (B) Horizontal fixation of the titanium plates was performed on the same patient. Two drainage catheters were placed under the pectoralis muscle layer. (C) Postoperative simple chest radiograph.

Mentions: Under general anesthesia, the previous median sternotomy incision was reopened and the wires were cut and removed. After debridement of all devitalized tissues and broken bone materials, sufficient irrigation with warm saline was performed. Both pectoralis major muscles were laterally undermined up to the mid-clavicular line in order to secure a sufficient area for titanium plate fixation. Both sides of the remnant thoracic wall were brought together, and the plate's types and sizes were chosen to fit each patient's thoracic wall. This plate fixation system (Angled Universal Fracture Plate; AO Foundation, Davos Platz, Switzerland) consists of 2-mm-thick titanium plates that have multiple holes for screw fixation (Table 1). After measurement to determine the appropriate lengths of the plates, the plates were cut, shaped, and fixed to the corresponding costal segments using 2-3 titanium screws per side (Fig. 1). The pectoralis major muscle or omental flap was plugged to fill the tissue defects following extensive debridement (Fig. 2). After sufficient irrigation with warm saline, a draining catheter was interposed beneath the pectoralis major muscle layer. Over the titanium plates, the undermined pectoralis muscle layer was closed using multiple interrupted sutures. Adequate antibiotic therapy was administered according to the bacterial sensitivity tests of the wound swab cultures.


Titanium plate fixation for sternal dehiscence in major cardiac surgery.

Kim WK, Kim JB, Kim GS, Jung SH, Choo SJ, Chung CH, Lee JW - Korean J Thorac Cardiovasc Surg (2013)

Fixation of transverse titanium plates for dehisced sternum (patient #1). (A) Intra-operative findings of sternal dehiscence with purulent discharge which are indicative of sternal osteomyelitis (following aortic valve replacement and coronary artery bypass). (B) Horizontal fixation of the titanium plates was performed on the same patient. Two drainage catheters were placed under the pectoralis muscle layer. (C) Postoperative simple chest radiograph.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756159&req=5

Figure 1: Fixation of transverse titanium plates for dehisced sternum (patient #1). (A) Intra-operative findings of sternal dehiscence with purulent discharge which are indicative of sternal osteomyelitis (following aortic valve replacement and coronary artery bypass). (B) Horizontal fixation of the titanium plates was performed on the same patient. Two drainage catheters were placed under the pectoralis muscle layer. (C) Postoperative simple chest radiograph.
Mentions: Under general anesthesia, the previous median sternotomy incision was reopened and the wires were cut and removed. After debridement of all devitalized tissues and broken bone materials, sufficient irrigation with warm saline was performed. Both pectoralis major muscles were laterally undermined up to the mid-clavicular line in order to secure a sufficient area for titanium plate fixation. Both sides of the remnant thoracic wall were brought together, and the plate's types and sizes were chosen to fit each patient's thoracic wall. This plate fixation system (Angled Universal Fracture Plate; AO Foundation, Davos Platz, Switzerland) consists of 2-mm-thick titanium plates that have multiple holes for screw fixation (Table 1). After measurement to determine the appropriate lengths of the plates, the plates were cut, shaped, and fixed to the corresponding costal segments using 2-3 titanium screws per side (Fig. 1). The pectoralis major muscle or omental flap was plugged to fill the tissue defects following extensive debridement (Fig. 2). After sufficient irrigation with warm saline, a draining catheter was interposed beneath the pectoralis major muscle layer. Over the titanium plates, the undermined pectoralis muscle layer was closed using multiple interrupted sutures. Adequate antibiotic therapy was administered according to the bacterial sensitivity tests of the wound swab cultures.

Bottom Line: Two patients required additional soft tissue wound revisions.Another patient presented with a tuberculous wound infection which was resolved using anti-tuberculosis medications.The postoperative course was uncomplicated in the other 13 patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea.

ABSTRACT

Background: Sternal dehiscence is one of the most troublesome complications following cardiac surgery. Treatment failure and consequent lethal outcomes are very common. The aim of this study was to evaluate titanium plate fixation as a treatment for sternal dehiscence following major cardiac surgery.

Materials and methods: Between 2010 and 2012, 17 patients underwent sternal reconstruction using horizontal titanium plating for the treatment of post-cardiac-surgery sternal dehiscence. The plates were cut and shaped, and then were fixed to corresponding costal segments using 2-3 titanium screws per each side.

Results: The median age of our patients was 66 years (range, 50 to 78 years) and 9 were female. Indications for sternal reconstruction included aseptic sternal dehiscence in 3 patients and osteomyelitis in 14 patients including 6 patients who were diagnosed with mediastinitis. During the operation, sternal resection and autologous flap interposition were combined in 11 patients. One patient died due to sepsis. Two patients required additional soft tissue wound revisions. Another patient presented with a tuberculous wound infection which was resolved using anti-tuberculosis medications. The postoperative course was uncomplicated in the other 13 patients.

Conclusion: Titanium plate fixation that combines appropriate debridement and flap interposition is very effective for the treatment of sternal dehiscence following major cardiac surgery.

No MeSH data available.


Related in: MedlinePlus