Postoperative transverse sternal nonunion with a chest wall defect managed by a tibial locking plate and a Gore-Tex dual mesh membrane: a case report

Abstract

Background Transverse sternal nonunion is a rare but disabling complication of chest trauma or a transverse sternotomy. Fixation methods, mainly used to manage the more common longitudinal sternal nonunion, often fail, leaving the surgical treatment of transverse nonunion to be a challenge. Case presentation We present a case of a highly-disabling, postoperative chest wall defect resulting from transverse sternal nonunion after a transverse thoracosternotomy (clamshell incision) and a concomitant rib resection. Following unsuccessful surgical attempts, the sternal nonunion was fixed with a tibial locking plate and bone grafted, while the post-rib resection chest defect was reconstructed with a Gore-Tex dual mesh membrane. Adequate chest stability was achieved, enabling complete healing of the sternal nonunion and the patient’s complete recovery. Conclusion We believe it is important to address both in the rare case of combined postoperative transverse sternal nonunion and the chest wall defect after rib resection. A good outcome was achieved in our patient by fixing the nonunion with an appropriately sized and shaped locking plate with bone grafting and covering the chest defect with a dual mesh membrane.

Double-Barrel Vascularized Free Fibula Flap for Reconstruction of Sternal Nonunion with Bone Defect

“…A n unstable chest wall can cause paradoxical motion that impairs respiratory function and discomfort with movement 8,9 . A stable, long-lasting reconstruction is important, but the sternum's multidirectional movement under tension and compression forces that act in all planes make reconstruction challenging 2,4,5 . Current approaches to managing sternal nonunion involve rigid sternal fixation, which provides chest wall stability and minimizes risk of lung volume depletion and paradoxical chest wall movement 8 .…”

“…Sternal nonunion is a rare complication in sternal fractures and sternotomy, with an incidence of <1% and 6.8%, respectively 1,2 . It has been associated with significant morbidity and increased risk of osteomyelitis, mediastinitis, and deep space infections, all of which have high mortality rates 3 .…”

“…It has been associated with significant morbidity and increased risk of osteomyelitis, mediastinitis, and deep space infections, all of which have high mortality rates 3 . Sternal reconstruction remains a challenge because of the multidirectional movements of chest wall with tension and compression forces in all planes 2,4,5 . Current reconstructive efforts rely on synthetic implants and rigid fixation plates, yet these have been associated with risk of infection, hardware failure, and other long-term complications 6 .…”

Pedicled myocutaneous flap transplantation for a large chest wall defect with infection in a 72-year-old female

“…There is no fixed surgical method for repairing large chest wall defects, and the specific method should be flexibly mastered based on the patient's overall condition, defect site, size, and surrounding available tissue conditions. Typically, thoracic reconstruction utilizes various soft tissue materials, such as latissimus dorsi muscle flap or myocutaneous flap, pectoralis major muscle flap or myocutaneous flap, rectus abdominis muscle flap or myocutaneous flap, free vastus lateralis myocutaneous flap and greater omentum flap [ [6] , [7] , [8] ]. In clinical settings, the preference for autologous tissue in repairing chest wall defects stems from its readily available nature, lack of immune rejection, and consistently dependable outcomes.…”