Surgical treatment of complicated sternal non-union using multiperforated titanium plates

Amaç: Bu çalışmada, sekiz koroner arter bypass greftleme (KABG) hastasında titanyum plaka ve vida kullanılarak sternal ayrılmanın düzeltilmesine yönelik farklı bir cerrahi yaklaşım sunuldu.Çalışma planı: Kraniyofasyal tespit için tanımlanmış olan Leibinger® çokdelikli titanyum plaka ve titanyum vida sistemi sekiz KABG hastasında (5 erkek, 3 kadın; ort. yaş 76.4 yıl; dağılım 67-84 yıl) sternumun tekrar onarımı ve tespiti için çelik telle beraber kullanıldı.Bulgular: Sternal stabilite ve tespit tüm hastalarda başarıyla sağlandı. İki yıllık klinik takiplerde herhangi bir komplikasyon görülmedi.Sonuç: Sternumun tekrar ayrılması cerrahi olarak tedavi edilmediğinde hastanede yatış süresini uzatan, mortalite ve morbiditeye neden olabilen ciddi bir komplikasyondur. Cerrahi yöntemimiz sternumun komplike ayrılmalarının cerrahi tedavisinde uygulanabilir.

Komplike sternal ayrılmaların çok delikli titanyum plaka kullanılarak cerrahi tedavisi

Background: In this study, we present a different surgical technique for correction of sternal non-union with the use of titanium plates and screws in eight coronary artery bypass grafting (CABG) patients.Methods: The Leibinger® titanium multiperforated titanium plate and screw system described for craniofacial fixation was used together with steel wires for re-correction and fixation of sternal non-union in eight CABG patients (5 males, 3 females; mean age 76.4 years; range 67 to 84 years).Results: Sternal stability and fixation were achieved successfully in all cases. No complications were seen at two years clinical follow-up.Conclusion: Sternal non-union and dehiscence is a severe complication that causes prolonged hospitalization and increased mortality and morbidity if the patient is not treated. Our surgical approach can be used for surgical treatment of complicated sternal non-union.

PDF

___

1) Satta J, Lahtinen J, Räisänen L, Salmela E, Juvonen T. Options for the management of poststernotomy mediastinitis. Scand Cardiovasc J 1998;32:29-32.
2) El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg 1996;61:1030-6.
3) Sunil I, Bond SJ, Nagaraj HS. Primitive neuroectodermal tumor of the sternum in a child: resection and reconstruction. J Pediatr Surg 2006;41:e5-8.
4) Saito T, Iguchi A, Sakurai M, Tabayashi K. Biomechanical study of a poly-L lactide (PLLA) sternal pin in sternal closure after cardiothoracic surgery. Ann Thorac Surg 2004;77:684-7.
5) Negri A, Manfredi J, Terrini A, Rodella G, Bisleri G, El Quarra S, et al. Prospective evaluation of a new sternal closure method with thermoreactive clips. Eur J Cardiothorac Surg 2002;22:571-5.
6) Dogan OF, Oznur A, Demircin M. A new technical approach for sternal closure with suture anchors (Dogan technique). Heart Surg Forum 2004;7:E328-32.
7) Dogan OF, Demircin M, Duman U, Ozsoy F, Acaroglu E. The use of suture anchors for sternal nonunion as a new technical approach (Demircin-Dogan technique). Heart Surg Forum 2005;8:E364-9.
8) Hendrickson SC, Koger KE, Morea CJ, Aponte RL, Smith PK, Levin LS. Sternal plating for the treatment of sternal nonunion. Ann Thorac Surg 1996;62:512-8.
9) Coons DA, Pitcher JD, Braxton M, Bickley BT. Sternal nonunion. Orthopedics 2002;25:89-91.
10) Eich BS, Heinz TR. Treatment of sternal nonunion with the Dall-Miles cable system. Plast Reconstr Surg 2000;106:1075-8.
11) Bertin KC, Rice RS, Doty DB, Jones KW. Repair of transverse sternal nonunions using metal plates and autogenous bone graft. Ann Thorac Surg 2002;73:1661-2.
12) Wu LC, Renucci J, Song DH. Rigid-plate fixation for the treatment of sternal nonunion. J Thorac Cardiovasc Surg 2004;128:623-4.
13) Tavilla G, van Son JA, Verhagen AF, Lacquet LK. Modified Robicsek technique for complicated sternal closure. Ann Thorac Surg 1991;52:1179-80.
14) Mansour KA, Thourani VH, Losken A, Reeves JG, Miller JI Jr, Carlson GW, et al. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg 2002;731720-5.
15) Yuen JC, Zhou AT, Serafin D, Georgiade GS. Long-term sequelae following median sternotomy wound infection and flap reconstruction. Ann Plast Surg 1995;35:585-9.
16) Robicsek F, Daugherty HK, Cook JW. The prevention and treatment of sternum separation following open-heart surgery. J Thorac Cardiovasc Surg 1977;73:267-8.
17) Pai S, Gunja NJ, Dupak EL, McMahon NL, Roth TP, Lalikos JF, et al. In vitro comparison of wire and plate fixation for midline sternotomies. Ann Thorac Surg 2005;80:962-8.
18) Ozaki W, Buchman SR, Iannettoni MD, Frankenburg EP. Biomechanical study of sternal closure using rigid fixation techniques in human cadavers. Ann Thorac Surg 1998;65:1660-5.
19) Mitra A, Elahi MM, Tariq GB, Mir H, Powell R, Spears J. Composite plate and wire fixation for complicated sternal closure. Ann Plast Surg 2004;53:217-21.
20) Voss B, Bauernschmitt R, Will A, Krane M, Kröss R, Brockmann G, et al. Sternal reconstruction with titanium plates in complicated sternal dehiscence. Eur J Cardiothorac Surg 2008;34:139-45.