Sternal reconstruction with titanium plates in complicated sternal dehiscence

Voß, Bernhard; Bauernschmitt, Robert; Will, Albrecht; Krane, Markus; Kröss, Ruth; Brockmann, Gernot; Libera, Paul; Lange, Rüdiger

doi:10.1016/j.ejcts.2008.03.030

Cited by 94 publications

(103 citation statements)

References 18 publications

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“…Moreover, in cases of transverse plate fracture, plate excision was needed due to the chronic pain that was reported. [15,16] In contrast, none of these complications were observed in our patients.…”

Section: Techniquecontrasting

confidence: 48%

“…Many studies have shown the superiority of rigid plate fixation over wire circulation for aggressive resection of the sternum. [11][12][13] The technique that we utilized has none of these complications, and thoracic stability was achieved in all of our patients.…”

Section: Techniquementioning

confidence: 98%

“…Also, bicortically placed screws may lead to the potential risk of graft damage due to the tip of the screw being located in the region of the underlying bypasses. [12,13,17,18] We fixed the plates to the ribs or sternum fragments with figure-of-eight wires because we believe that this technique leads to less damage to the ribs and sternum, and it provides more stability.…”

Section: Techniquementioning

confidence: 99%

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Longitudinal plate fixation technique after gross resection of the sternum or multiple sternal fracture

Taşoğlu¹

2013

Turk Gogus Kalp Dama

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Bu yazıda komplike sternal kapamalarda alternatif bir yol olarak longitudinal plak fiksasyonu tekniği kullanımı tanımlandı. Ocak 2008 -Eylül 2011 tarihleri arasında sternotomi sonrası longitudinal rijit plak fiksasyonu yapılan hastalar retrospektif olarak değerlen-dirildi. Sternum debridmanı sonrası tama yakın sternal kaybı olan ya da çoklu sternal kırığı bulunan yedi hasta (3 erkek, 4 kadın; ort. yaş 64.42 yıl; dağılım 30-74 yıl) sternal ayrılma için yüksek riskli olarak tanımlandı. Sternal kaynamaması olan bu hastalarda 10 kez tekrar longitudinal plak fiksasyonu uygulandı. Hastaların ikisinde (%29) tama yakın sternal kayıp, beşinde (%71) ise çoklu sternal kırık vardı. Sternal instabilitesi olan bu hastalar ön göğüs duvarında titanyum plaklar ve çelik teller kullanılarak ameliyat edildi. Uzun dönemde çok az rahatsızlık hissinin dışında, bütün hastalarda ameliyat sonrası göğüs ağrısı kayboldu. Tama yakın sternal kayıp olgularında ve çoklu sternal kırıklarda, longitudinal sternal plak ve çelik tellerin kullanımı efektif bir seçenektir. Kullanımı kolay olan bu teknik, daha az komplikasyonla da ilişkilidir.Anah tar söz cük ler: Ayrılma; fiksasyon; plak; sternum.In this article, we described an alternative way for complicated sternal closure by using a longitudinal plate fixation technique. A retrospective analysis between January 2008 and September 2011 was performed on patients who received primary longitudinal rigid plate fixation after sternotomy. Seven patients (3 males, 4 females; mean age 64.4±14.3 years; range 30 to 74 years) with multiple sternal fractures or near-total loss after sternal debridement were defined as having high-risk for sternal dehiscence. We performed 10 longitudinally sternal plate refixation in these patients with sternal nonunion. Two patients (29%) had near-total sternal loss, while five patients (71%) had multiple sternal fractures. The patients suffering from sternal instability were operated using the titanium plates and steel wires for the anterior chest wall. Postoperative chest pain disappeared in all patients with only minor discomfort in the long-term. Longitudinal sternal plating and steel wires are an effective option for the treatment in patients with near-total sternal loss and multiple sternal fractures. This technique which is easy to use seems to be associated with fewer complications.

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Section: Techniquecontrasting

confidence: 48%

Section: Techniquementioning

confidence: 98%

Section: Techniquementioning

confidence: 99%

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Longitudinal plate fixation technique after gross resection of the sternum or multiple sternal fracture

Taşoğlu¹

2013

Turk Gogus Kalp Dama

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“…Providing a more stable osteotomy and improving sternal osteosynthesis is the best way to prevent these complications [3,4,27,28] . More than 40 different techniques with various materials have been described for sternal closure [12][13][14][15][16] . Most techniques revolve around a different pattern of wire cerclage, rigid plate fixation, or various non-rigid methods of closure [29][30][31][32][33][34][35][36] .…”

Section: Discussionmentioning

confidence: 99%

“…Providing greater stability [3,4,6] and promoting primary osseous healing is crucial for preventing these complications [7][8][9][10][11] . More than 40 different techniques have been described for closing median sternotomy [12][13][14][15][16] . The biomechanical characteristics of different sternal closures may substantially improve sternotomy reduction and stability [17][18][19] .…”

Section: Introductionmentioning

confidence: 99%

Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

Küçükdurmaz

Ağır²,

Bezer³

2013

WJO

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AIM:To increase the stability of sternotomy and so decrease the complications because of instability. METHODS:Tests were performed on 20 fresh sheep sterna which were isolated from the sterno-costal joints of the ribs. Median straight and interlocking sternotomies were performed on 10 sterna each, set as groups 1 and 2, respectively. Both sternotomies were performed with an oscillating saw and closed at three points with a No. 5 straight stainless-steel wiring. Fatigue testing was performed in craniocaudal, anterio-posterior (AP) and lateral directions by a computerized materials-testing machine cycling between loads of 0 to 400 N per 5 s (0.2 Hz). The amount of displacement in AP, lateral and craniocaudal directions were measured and also the op- posing bone surface at the osteotomy areas were calculated at the two halves of sternum. BRIEF ARTICLE RESULTS:The mean displacement in cranio-caudal direction was 9.66 ± 3.34 mm for median sternotomy and was 1.26 ± 0.97 mm for interlocking sternotomy, P < 0.001. The mean displacement in AP direction was 9.12 ± 2.74 mm for median sternotomy and was 1.20 ± 0.55 mm for interlocking sternotomy, P < 0.001. The mean displacement in lateral direction was 8.95 ± 3.86 mm for median sternotomy and was 7.24 ± 2.43 mm for interlocking sternotomy, P > 0.001. The mean surface area was 10.40 ± 0.49 cm² for median sternotomy and was 16.8 ± 0.78 cm² for interlocking sternotomy, P < 0.001. The displacement in AP and cranio-caudal directions is less in group 2 and it is statistically significant. Displacement in lateral direction in group 2 is less but it is statistically not significant. Surface area in group 2 is significantly wider than group 1. CONCLUSION:Our test results demonstrated improved primary stability and wider opposing bone surfaces in interlocking sternotomy compared to median sternotomy. This method may provide better healing and less complication rates in clinical setting, further studies are necessary for its clinical implications.

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Sternal fixation techniques following sternotomy for preventing sternal wound complications

Pinotti

Dib

Catâneo

et al. 2014

Cochrane Database of Systematic Reviews

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Sternal reconstruction with titanium plates in complicated sternal dehiscence

Abstract: Titanium plate fixation is an effective method to stabilize complicated sternal dehiscence. The longitudinal plating technique is easier to apply and seems to be associated with fewer complications.

Cited by 94 publications

References 18 publications

Longitudinal plate fixation technique after gross resection of the sternum or multiple sternal fracture

Longitudinal plate fixation technique after gross resection of the sternum or multiple sternal fracture

Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

Sternal fixation techniques following sternotomy for preventing sternal wound complications

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