Combination plate and band fixation for primary closure in bilateral lung transplantation

Abstract

Background Sternal complications are common following transverse thoracosternotomy in patients undergoing bilateral lung transplantation. We present a single‐institution experience using a next generation rigid fixation system for primary sternal closure following transverse sternotomy for bilateral lung transplantation. Methods Retrospective review was performed on all patients who had bilateral sequential lung transplants utilizing a transverse thoracosternotomy from 2016 to 2020. Demographics, baseline characteristics, peri‐operative data, and outcomes were collected, reviewed and summarized. Two groups of patients were identified: wire cerclage (Group A), combination plate‐and‐band rigid fixation (Group B). The primary outcome was sternal complications, which were divided into mechanical and non‐mechanical. Results Twenty‐two patients met inclusion criteria. Three patients (13.6%) were in Group A, nineteen patients (86.4%) in Group B. Two patients in each Group A (66.6%) and Group B (10.5%) experienced a sternal complication. Sternal complications included sternal dehiscence (2), sternal malunion (1), and surgical site infection (1). One patient with plate‐and‐band fixation (5.2%) had a mechanical sternal complication. Three patients required reoperation secondary to sternal complication. Conclusions The utilization of a combination plate‐and‐band rigid fixation system for primary closure is safe and may be an effective method to reduce sternal complications following transverse thoracosternotomy for lung transplantation.

A Comparative Study of a Sternum-Sparing Procedure and Clamshell Incision in Bilateral Lung Transplantation

“…Although plate fixation is generally adequate for long bone fractures or mid-sternotomy, the plating technique is inappropriate as a sternal fixation method in patients with transverse sternotomy affected by excessive outward translation and paradoxical abdominal movement. Recently, Boudreaux, et al 10 reported that sternal complications in clamshell incision lung transplantation could be reduced by applying plate fixation as the primary sternal closure technique. Our experience shows that titanium plate fixation is similar to conventional sternal wiring fixation, such as the primary sternal fixation technique for transverse sternotomy.…”