Abstract
BackgroundMedian sternotomy infection and bony nonunion are two commonly described complications which occur in 0.4 - 5.1% of cardiac procedures. Although relatively infrequent, these complications can lead to significant morbidity and mortality. The aim of this retrospective study is to evaluate the initial experience of a transverse plate fixation system following wound complications associated with sternal dehiscence with or without infection following cardiac surgery.MethodsA retrospective chart review of 40 consecutive patients who required sternal wound reconstruction post sternotomy was performed. Soft tissue debridement with removal of all compromised tissue was performed. Sternal debridement was carried using ronguers to healthy bleeding bone. All patients underwent sternal fixation using three rib plates combined with a single manubrial plate (Titanium Sternal Fixation System®, Synthes). Incisions were closed in a layered fashion with the pectoral muscles being advanced to the midline. Data were expressed as mean ± SD, Median (range) or number (%). Statistical analyses were made by using Excel 2003 for Windows (Microsoft, Redmond, WA, USA).ResultsThere were 40 consecutive patients, 31 males and 9 females. Twenty two patients (55%) were diagnosed with sternal dehiscence alone and 18 patients (45%) with associated wound discharge. Thirty eight patients went on to heal their wounds. Two patients developed recurrent wound infection and required VAC therapy. Both were immunocompromised. Median post-op ICU stay was one day with the median hospital stay of 18 days after plating.ConclusionSternal plating appears to be an effective option for the treatment of sternal wound dehiscence associated with sternal instability. Long-term follow-up and further larger studies are needed to address the indications, benefits and complications of sternal plating.
Highlights
Median sternotomy infection and bony nonunion are two commonly described complications which occur in 0.4 - 5.1% of cardiac procedures
The current standard technique for sternal closure remains the cerclage stainless steel wires. This technique under normal physiologic loads can lead to inadequate fixation and sternal dehiscence [3]
This happens when mechanical stresses are concentrated at the steel wires, causing them to cut into the bone, and allowing variable degrees of motion to occur at the closure site
Summary
Median sternotomy infection and bony nonunion are two commonly described complications which occur in 0.4 - 5.1% of cardiac procedures. Relatively infrequent, these complications can lead to significant morbidity and mortality. The current standard technique for sternal closure remains the cerclage stainless steel wires This technique under normal physiologic loads can lead to inadequate fixation and sternal dehiscence [3]. This happens when mechanical stresses are concentrated at the steel wires, causing them to cut into the bone, and allowing variable degrees of motion to occur at the closure site. Effective rigid closure of the sternum may prevent post-sternotomy mediastinitis by affording greater stability and promoting primary healing of the sternum
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