Surgical reconstruction of the sternum following cardiac surgery complicated by mediastinitis—implantation of a custom-made sternal implant: a case report

Abstract

: Mediastinitis represents an uncommon but potentially life-threatening complications following median sternotomy. There remains a lack of consensus regarding the optimal treatment option(s). Custom tridimensional titanium printing provides an effective method for construction of complex prothesis. We report the case of a 49-year-old female with previous sternal dehiscence and deep wound infection following coronary artery bypass grafts, necessitating sternectomy. A year later, she presented with chronic severe pain and audible crepitations of her ribs/clavicles. Lack of identification of a mechanical cause, poor localisation and suboptimal medical pain management culminated in the consideration for a novel approach for sternal reconstruction. By way of bridging the final placement of the titanium prothesis, the patient underwent placement of a methyl methacrylate spacer. The surgical approach involved the removal of the temporary spacer, with tissue samples taken to guide post-operative antimicrobial therapy. Concurrently, the reaming, irrigation and aspiration technique of bone marrow harvesting, for seeding of the central web structure of the implant, was employed under fluoroscopic guidance. Following adequate dissection under the pectoral muscle, and debridement of the anterior chest wall, final placement of the prothesis was made via bicortical fixation to the ribs. Finally, the mobilised pectoral muscles were sutured medially and fixed to the previously placed rectus abdominis flap. Three-dimensional printing of a custom prosthesis offers a novel and effective approach to full reconstruction; maintaining pulmonary mechanics and stability of the anterior chest wall