Anterior chest wall reconstruction using transverse plate fixation system in complicated sternotomy wound
Authors:
M. Rezler; D. Čoček; V. Kurfirst; M. Forst; L. Pešl; A. Mokráček
Authors‘ workplace:
Primář: MUDr. Aleš Mokráček, CSc.
; Kardiocentrum – kardiochirurgie, Nemocnice České Budějovice, a. s.
Published in:
Prakt. Lék. 2009; 89(4): 199-202
Category:
Of different specialties
Overview
The authors report two cases of complicated deep sternal wound infection with sternal dehiscence and extensive bone defects. Debridement, vacuum-assisted closure device (KCL Inc, San Antonio, TX), antibiotic therapy based on wound culture and following reconstruction of the anterior chest wall using rigid transverse sternal plates was managed for definitive closure. Postoperative period was complicated by temporary seroma formation under the dissected pectoralis muscle flaps in both patients. At short-term follow-up (3 months) the sternum was stable and soft tissues had healed. This relatively new sternal fixation technique is a safe and effective alternative to the more commonly used wire techniques and broadens the spectrum for the closure of complicated sternal wounds.
Key words:
sternotomy, deep wound infection, sternal dehiscence, rigid plate fixation.
Sources
1. Rezler, M., Mokráček, A., Čoček, D. a kol. Naše první zkušenost s rigidní fixací sterna. Rozhl. Chir. 2007, 86, s. 410-414.
2. Losanoff, J.E., Jones, J.W., Richman, B.W. Primary closure of median sternotomy: techniques and principles. Cardiovasc. Surg. 2002, 10, p.102-110.
3. Loop, F.D., Lytle, B.W., Cosgrove, D.M.J. Maxwell Chamberlain memorial paper: sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity and cost of care. Ann. Thorac. Surg. 1990, 49, p. 179-186.
4. Shroyer, A.L.W., Coombs, L.P., Peterson, E.D. et al. The Society of Thoracic Surgeons: 30-day operative mortality and morbidity risk models. Ann. Thorac. Surg. 2003, 31, p. 481-498.
5. Immer, F.F., Durrer, M., Muhlemann, K.S. et al. Deep sternal wound infection after cardiac surgery: modality of treatment and outcome. Ann. Thorac. Surg. 2005, 80, p. 957-961.
6. El Oakley, R.M., Wright, J.E. Postoperative mediastinitis: Classification and management. Ann. Thorac. Surg. 1996, 61, p. 1030-1036.
7. Robicsek, F., Daugherty, H.K., Cook, J.W. The prevention and treatment of sternum separation following open-heart surgery. J. Thorac. Cardiovasc. Surg. 1977, 73, p. 267-268.
8. Peivandi, A.A., Kasper-Konig, W., Quinkenstein, E. et al. Risk factors influencing the outcome after surgical treatment of complicated deep sternal wound infection after median sternotomy. Cardiovasc. Surg. 2003, 11, p. 207-212.
9. Plass, A., Grunenfelder, J., Reuthebuch, O. et al. New transverse plate fixation system for complicated sternal wound infection after median sternotomy. Ann. Thorac. Surg. 2007, 83, p. 1210-1212.
10. Cicilioni, O.J., Stieg, F.H., Papanicolau, G. Sternal wound reconstruction with transverse plate fixation. Plast. Reconstr. Surg. 2005, 115, p. 1297-1303.
11. Hallock, G.G., Szydlowski, G.W. Rigid fixation of the sternum using a new coupled titanium transverse plate fixation systém. Ann. Plast. Surg. 2007, 58, p. 640-644.
12. Almodovar, L.F., Bustos, G., Lima, P. et al. Transverse plate fixation of sternum: a new sternal-sparing technique. Ann. Thorac. Surg. 2008, 86, p. 1016-1017.
13. Huh, J., Bakaeen, F., Chu, D., Wall, M.J. Transverse sternal plating in secondary sternal reconstruction. J. Thorac. Cardiovasc. Surg. 2008, 136, p. 1476-1480.
14. Hendrickson, S.C., Koger, K.E., Morea, C.J. et al. Sternal plating for the treatment of sternal nonunion. Ann. Thorac. Surg., 1996, 62, p. 512-518.
15. Ozaki, W., Buchman, S.R., Iannettoni, M.D. et al. Biomechanical study of sternal closure using rigid fixation techniques in human cadavers. Ann. Thorac. Surg., 1998, 65, p. 1660-1665.
16. Pai, S., Gunja, N.J., Dupak, E.L. et al. In vitro comparison of wire and plate fixation for midline sternotomies. Ann. Thorac. Surg., 2005, 80, p. 962-968.
17. Cohen, D.J., Griffin, L.V. A biomechanical comparison of three sternotomy closure techniques. Ann. Thorac. Surg., 2002, 73, p. 563-568.
18. Sargent, L.A., Seyfer, A.E., Hollinger, J. et al. The healing sternum: a comparison of osseous healing with wire versus rigid fixation. Ann. Thorac. Surg., 1991, 52, p. 490-494.
19. Song, D.H., Lohman, R.F., Renucci, J.D. et al. Primary sternal plating in high – risk patients prevents mediastinitis. Europ. J. Cardiothorac. Surg., 2004, 26, p. 367-372.
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