Abstract
Sternal refixation or reconstruction of a median sternotomy can be indicated after treatment of deep sternal wound infection or bony non-union. Synthes® Titanium Sternal Fixation System is routinely used for sternal refixation. To perform a stable reconstruction, the titanium plates need to be bent to the anatomical shape of the sternum and adjacent ribs. The procedure offers good results, but can be, especially in the case of a complex non-union or a complex anatomy, time-consuming. Based on pre-operative CT-scan a 3D model of the sternum was printed (Materialise, Belgium). The operation was simulated using 3D software (Materialise, Belgium) and the two parts were aligned. The titanium plates were bent to fit the anatomical shape of the 3D model pre-operatively. During surgery the plates were fitted and if necessary additional bending was performed. Case 1: Total pre-operative bending time for the relatively simple anatomic shape and mal-union was 53 minutes. Total operative time was 1 hour 19 minutes. Case 2: Total pre-operative bending time for a complicated non-union and anatomy was 1 hour 21 minutes. Total operative time was 1 hour 43 minutes. Because of pre-operative bending, total operative time could be reduced by approximately 40-45%. Additional bending was rarely necessary. This case series demonstrates that the use of 3- dimensional planned patient-specific guides and preoperative preparations can help reduce operating time with satisfactory preliminary results.
Highlights
A secondary sternal fixation or reconstruction of a medial sternotomy can be indicated after median sternotomy infection or bony non-union
Working with Materialise (Leuven, Belgium), we developed a technique using 3dimensional planning and patient specific surgical 3D-printed guide to simplify and quicken the procedure
We describe how we perform a secondary sternal refixation after non-union of a medial sternotomy using a preprinted 3D model of the patient’s sternum to achieve reduction in operating time
Summary
A secondary sternal fixation or reconstruction of a medial sternotomy can be indicated after median sternotomy infection or bony non-union. Rare, they go accompanied with significant morbidity [1]. In our center we routinely use Synthes® Titanium Sternal Fixation System for a secondary sternal reconstruction after bony non-union or after healing of median sternotomy infection. To perform a good reconstruction the titanium plates, need to be bent to the anatomical shape of the sternum and adjacent ribs, to ensure stable refixation, this part of the perioperative procedure is very time-consuming. Three-dimensional planning based on computed tomography images of the mal-united and non-united sternum enabled us to produce a patient-specific 3D printed sternum and enabled us to custom pre-bend the titanium plates.
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