Sternal Research Articles

A randomized trial comparing the effects of sternal band and plate fixation of the sternum with that of figure-of-8 wires on sternal edge motion and quality of recovery after cardiac surgery.

We sought to compare the effects of conventional wire cerclage with that of the band and plate fixation of the sternum. A parallel randomized open-label trial with 1:1 allocation ratio compared healing after adult cardiac surgery using 'figure-of-8' stainless steel wire cerclage or a band and plate system (plates). The primary end point was maximal sternal edge displacement during active coughing of ≥2 mm in ≥2 of 4 sites measured with ultrasound by 2 assessors blinded to the other at 6 weeks postoperatively. Secondary end points at 12 weeks included ultrasound assessment, computed tomography (CT) scan and multidimensional assessment of quality of recovery using the Postoperative Quality of Recovery Scale. Of 50 patients, 26 received plates and 24 wires. Two patients died and 1 withdrew consent leaving 25 plates and 22 wires for primary end point analysis. Operations included 37 coronary, 5 valve and 8 combined coronary and valve procedures. At 6 weeks, less sternal movement was observed in patients with plates than those with wires, 4% (1/25) vs 32% (7/22), P = 0.018. Agreement between observers was high, kappa = 0.850. At 12 weeks, less ultrasound motion was seen in patients with plates, 0% (0/23) than those with wires, 25% (5/20), P = 0.014. Recovery from pain was higher for patients with plates 92% (22/24) than those with wires 67% (14/21), P = 0.004. CT bone edge separation was less for plates 38% (9/24) than wires 71% (15/21), P = 0.036. CT mild bone synthesis or greater was similar between patients with plates 21% (5/24) and wires 14% (3/21), P = 0.71. Patients receiving the band and plate system had significantly less sternal edge motion than those receiving wires, 6 and 12 weeks after cardiac surgery and experienced less pain. clinicaltrials.gov NCT03282578.

Shotgun wound to manubrium sterni, right anterior neck, and right supraclavicular area

A 38-year-old man presented to the trauma center with a close-range oblique shotgun wound to the manubrium sterni, right anterior neck, and right supraclavicular area. The patient was alert and...

No Need for Sternal Fixation in Traumatic Sternovertebral Fractures: Outcomes of a 10-Year Retrospective Cohort Study.

Study Design:Retrospective cohort study.Objectives:Combined sternal and spinal fractures are rare traumatic injuries and present a high risk of spinal and thoracic wall instability. Limited research has addressed the treatment of sternovertebral injuries and biomechanical need for sternal fixation to achieve spinal healing.Methods:A 10-year retrospective cohort study was conducted, including patients with sternovertebral fractures admitted to our level-1 trauma centre between 2007 and 2016. Patients who died during hospital admission, military patients, patients with isolated upper cervical spine or lower lumbar spine fractures, and patients lost to follow-up were excluded.Results:In 10 years, 73 patients with sternovertebral fractures were included. Mean injury severity score was 24 (range 4-57). Most sternal fractures were located in the sternal body and manubrium. Spinal fractures were type A (52%), B (40%), or C (8%), and were located in the subaxial cervical (21%), upper thoracic (16%), thoracic (21%), thoracolumbar (47%) area; 7 patients had spinal fractures at multiple levels. Fourteen patients (19%) had a neurological deficit. A total of 42 patients received conservative and 31 patients received operative spinal treatment. Two patients (3%) underwent primary sternal fixation. Sternal failure rate was 1% and biomechanical spinal failure rate was 8%, there was no difference in treatment failure between surgical and conservative spinal treatment. Associated thoracic injuries did not influence sternal or spinal treatment outcomes.Conclusions:These findings indicate that conservative sternal treatment in presence of spinal fractures is safe and effective. The low spinal treatment failure rates imply that sternal fixation is not necessary to achieve spinal stability.

Secondary cancer risk after radiation therapy for breast cancer with different radiotherapy techniques

The aim of this study was to estimate the radiation-related secondary cancer risks in organs during the treatment of breast cancer with different radiotherapy techniques, such as three-dimensional conformal radiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT). The treatment plans for 26 patients with breast cancer who received whole-breast irradiation at a dose of 50 Gy included tangential field 3D-CRT with hard-wedges (W-TF), tangential field IMRT (2F-IMRT), multiple field IMRT (6F-IMRT), and double partial arcs (VMAT). Patients were divided into three groups according to the distance between the contralateral breast (CB) and the body of the sternum. Setup error was simulated by moving the isocenter, and the dose distribution was then recalculated without changing the field fluency distribution. Based on the linear-exponential, the plateau, and the full mechanistic dose-response models, the organ equivalent dose and excess absolute risk were calculated from dose-volume histograms to estimate the secondary cancer risks in organs. Compared with 3D-CRT, IMRT and VMAT showed excellent results regarding tumor conformity and homogeneity; however, the low dose volume to organs was considerably higher in 6F-IMRT and VMAT. Secondary cancer risks for 2F-IMRT were comparable or slightly lower than for W-TF, but considerably lower than for 6F-IMRT or VMAT. After setup error simulation, there was a small increase in secondary cancer risk for 2F-IMRT and an increase of 159% and 318% for 6F-IMRT and VMAT, respectively, compared with W-TF. Although these results were obtained in most patients, they did not necessarily apply to every individual. The secondary cancer risks in the CB decreased significantly in correlation with increased distance for all alternative techniques, although they were higher in VMAT and lower in 2F-IMRT regardless of the distance. After setup error simulation, the increased changes in secondary cancer risks in the CB were comparable between 2F-IMRT, 6F-IMRT, and VMAT, suggesting that the secondary cancer risks in the CB mainly depend on radiotherapy techniques and distance, although the effect of setup error cannot be ignored. In the contralateral lung (CL), the secondary cancer risks were almost independent from distance and depended mainly on radiotherapy techniques; they were rarely affected by setup error. VMAT was associated with a higher secondary cancer risk in the CL. For the ipsilateral lung (IL), the secondary cancer risks were higher than those in other organs because the IL receives high doses to achieve tumor control, and they were relatively lower in VMAT. This warrants special consideration when estimating the secondary cancer risk to the IL. The study results suggested that the optimal radiotherapy method for breast cancer should be determined on an individual basis and according to the balance between secondary cancer risks related to anatomic diversity and setup error, which can prevent blind selection of techniques.

Clinical effect of right subaxillary small incision approach on children with congenital heart disease

Objective To analyze the clinical effect of right subaxillary small incision approach on children with congenital heart disease (CHD). Methods Eighty-six patients with CHD admitted to Henan Children′s Hospital from January 2015 to September 2017 were enrolled in this study.The patients were randomly divided into the control group and the observation group with 43 cases each group.The control group underwent sternal median incision, and the observation group underwent right subaxillary small incision.The total effective rate, incision satisfaction, general conditions of surgery (cardiopulmonary bypass time, operation time, aortic occlusion time, intraoperative blood loss), postoperative related conditions (thoracic drainage volume, postoperative monitoring time, postoperative assisted ventilation time, hospitalization time, hospitalization expenses), Wong-Baker facial expression scale (FPS-R) score, as well as the respiratory function index including the levels of peak inspiratory pressure (PIP) and alveolar-arterial oxygen pressure difference [p(A-a) (O2)]after anesthesia (T1), after operation (T2), at admission to intensive care unit (T3) and before extubation (T4) and complication rate between 2 groups were compared. Results (1)The incision satisfaction in the observation group [90.70% (39/43 cases)] was higher than that in the control group [62.79% (27/43 cases)], and the difference was statistically significant (χ2=9.382, P=0.002). (2)There was no significant difference in the the extracorporeal circulation time, operation time and aortic block time between the two groups [observation group: (68.94±8.26) min, (2.33±0.21) h, (28.79±7.32) min; control group: (67.11±9.11) min, (2.25±0.31) h, (30.02±6.88) min] (P>0.05). (3)The intraoperative blood loss [(89.87±11.25) mL] in the observation group was less than that in the control group [(105.91±31.01) mL], which difference was statistically significant (t=3.189, P=0.002). (4)Also there was significant difference in postoperative monitoring time, postoperative assisted ventilation time, hospitalization time, thoracic drainage volume and hospitalization expenses between the two groups (the observation group: postoperative monitoring time (30.55±10.39) h, postoperative assisted ventilation time [(9.68±2.19) h, hospitalization time (9.61±2.17) d, thoracic drainage volume (90.36±26.14) mL, hospitalization expenses (36 956.15±1 097.84) yuan; the control group: (41.39±9.93) h, (12.72±3.81) h, (12.33±3.15) d, (163.24±29.36) mL and (45 271.97±1 134.55) yuan] (t=4.946, 4.536, 4.663, 12.157, 34.540, all P 0.05). There was no significant difference in the complication rate between the observation group [6.98% (3/43 cases)] and the control group [4.65% (2/43 cases)] (χ2=0.000, P>0.05). Conclusions Right subaxillary small incision approach does not affect the respiratory function of children with CHD, which can improve the satisfaction of incision, reduce the amount of blood loss, accelerate postoperative recovery of children, relieve postoperative pain, and reduce the financial burden of parents.Besides, intra-operative proficient and accurate operations can reduce or avoid the occurrence of related complications and ensure the safety of surgery. Key words: Minimally invasive; Sternal median incision; Congenital heart disease; Small incision in right axillary; Child; Open surgery

Boncolás nyomai egy XVIII. századi gyermek mumifikálódott testén

In 1994–1995, in the Church of the Whites, the corpses of 265 individuals dressed in funeral clothes, mummified to varying degrees, were unearthed from coffins excavated by the ethnographic museologists of the Ignác Tragor Museum, Vác (Hungary). The individuals were preserved by spontaneous mummification due to the crypt’s unique microclimate and burial pattern.
 Signs of an autopsy were found on the body of a 10-year old girl, Maria Theresa of Swartz, who died on the 26th January 1784.
 Two incisions were seen on her body: the longitudinal incision extends from the manubrium sterni to the symphysis, the second one is perpendicular to it, and connects the two hip paddles. The wound edges were later sutured, and the suture was partially retained. Since there was no sign of any other opening in the body, the autopsy was apparently aimed at finding out the cause of death and was limited to the area of the suspected disease. Rapid miliary tuberculosis and extrapulmonary bone tuberculosis must have contributed to the child's death; this was demonstrated by radiological examinations and confirmed by paleomicrobiological examination (residues of Mycobacterium tuberculosis detected in pulmonary and extrapulmonary samples as well). Another hypothesis is that appendicitis might have caused the death of a child with advanced tuberculosis. In the case of appendicitis, the intestinal function may stop. Suspected abdominal complaints may also have been caused by extrapulmonary gastrointestinal tuberculosis.

Anaesthetic management of a child for excision of extensive facial neurofibroma extending to lower neck with airway compression

A 7-year-old girl presented with a large facial plexiform neurofibroma extending from the left infraorbital region downwards up to the manubrium sternum with laryngeal compression. The child was posted for excision of the tumour, which measured 30 cm × 20 cm. Following anaesthetic induction with inhalation agents, a videoscope-assisted nasal intubation was attempted but failed. Fibreoptic-assisted intubation also failed due to inability to railroad the tube into the trachea. Finally, a stylet was passed from the oral route into the trachea under videoscopic guidance, and a 5.5 mm ID endotracheal tube was passed over it. The intraoperative period was uneventful. The patient developed stridor on extubation in the intensive care unit (ICU) on the 1st postoperative day. Due to failed reintubation in the ICU and in view of need for a secure airway during the postoperative period, a tracheostomy was performed. Flexible bronchoscopy under general anaesthesia administered through the tracheostomy 1 week later revealed oedematous vocal cords, and hence decannulation was deferred. Repeat bronchoscopy after another week showed near-normal vocal cords, larynx and subglottic region. The child was then decannulated and had an unremarkable recovery.

A Novel Method for Monitoring SpO2 in Wearable Health Monitoring Applications

This study outlines the utility of a reflectance pulseoximeter sensor in Wearable Health Monitoring System (WHMS). Pulseoximeter has its own vital role in WHMS as it can provide additional crucial information about the physiological status. This paper discusses the data analysis for ambulatory utility of a reflectance pulseoximeter for variable locations on the body e.g. Finger, forehead, chest. Different physical factors affecting the performance of spo2 sensor are considered and discussed. An experiment simulating ambulation was conducted with Nonin reflectance sensor against standard sensor is capable for its utility in variable motions. We also compared variable locations data against standard positions like Forehead and Fingertip during rest conditions, the outcome of which proved that the Manubrium sternum can be utilized as a site of location for the measurement of spo2 with respect to a single emitter and detector sensor.

A Novel Method for Monitoring SpO2 in Wearable Health Monitoring Applications

This study outlines the utility of a reflectance pulseoximeter sensor in Wearable Health Monitoring System (WHMS). Pulseoximeter has its own vital role in WHMS as it can provide additional crucial information about the physiological status. This paper discusses the data analysis for ambulatory utility of a reflectance pulseoximeter for variable locations on the body e.g. Finger, forehead, chest. Different physical factors affecting the performance of spo2 sensor are considered and discussed. An experiment simulating ambulation was conducted with Nonin reflectance sensor against standard sensor is capable for its utility in variable motions. We also compared variable locations data against standard positions like Forehead and Fingertip during rest conditions, the outcome of which proved that the Manubrium sternum can be utilized as a site of location for the measurement of spo2 with respect to a single emitter and detector sensor.

A new method for establishing a ventricular fibrillation model by TCEI in Tibetan miniature pig

To explore an economical, convenient, safe and efficient method for establishing a Tibetan miniature pig model of cardiac arrest (CA). Cardiac puncture was performed in 12 Tibetan miniature pigs using two acupuncture needles. One needle was inserted into the fourth intercostal near the right side of the sternum about 3 cm in depth at an angle of 30° to 60° between the chest and the needle, and the depth was adjusted until the handle of the needle vibrated with the heartbeat without premature ventricular contraction on the electrocardiogram; the other was inserted into the subcutaneous tissue of the left armpit about 3 cm in depth without damaging important organs. The handles of the two needles were connected with 9V dry batteries to form a circuit and generate direct current stimulation. Ventricular fibrillation was produced in the pigs to induce CA by stimulation of transcutaneous electrical induction (TCEI) for 3 s, and the success rate of modeling was recorded. After an interval of 4 min without intervention, cardiopulmonary resuscitation (CPR) was performed using the standard Utstein style, and the survival of the pigs after recovery was observed. The success rate of ventricular fibrillation modeling was 91.67% (11/12) using this method, and CPR achieved a success rate of 45.45% (5/11) in these models. The subsequent survival of the pigs was 100% (5/5) at 24 h and 80% (4/5) at 72 h. After observation for 72 h, the resuscitated Tibetan miniature pigs were dissected, and no significant damage was found in the vital organs in the thoracic or abdominal cavities. We successfully established a model of CA using acupuncture needles and dry batteries in Tibetan miniature pigs, and this method is economical, convenient, safe and efficient.

Necrotizing soft tissue infection at an uncommon site following tooth extraction

Necrotizing soft tissue infection (NSTI) is a disease characterized by rapidly progressive necrosis involving skin, subcutaneous tissue, fascia or muscle. It is commonly seen in extremities, perineum and lower abdomen. It is extremely uncommon for necrotizing fasciitis to occur along the chest wall, with only a few such cases being reported. We report one such rare case of NSTI in a 75 year old male who underwent left molar tooth extraction developed Ludwig’s angina which progressed to present as a painful swelling over the left side of the neck and chest with a necrotic patch of skin over manubrium sternum managed successfully.

A new species of Tenothrips pollinating Dipterocarpus sublamellatus in Malaysia.

Tenothrips keruing sp. n. is described from Malaysia. This new species was taken from the flowers of Dipterocarpus sublamellatus (local name Keruing kerut) during the recent mass-flowering. The male of this species has a pair of stout setae on abdominal tergite IX, and there are no sternal pore plates. A key to species of Tenothrips from Indomalaysia is provided.

Clinical value of right ventricular morphology in children with congenital heart disease associated pulmonary hypertension

Objective To investigate clinical value of right ventricular morphology in children with congenital heart disease associated pulmonary hypertension. Methods From October 2014 to October 2017, 37 children with congenital heart disease without associated pulmonary hypertension (resting pulmonary systolic pressure ≤ 30 mmHg, 1 mmHg=0.133 kPa) were selected as group A. Thirty-seven children with congenital heart disease and associated pulmonary hypertension (resting pulmonary systolic pressure>30 m). were in group B, and 37 healthy children were in control group.Echocardiography was performed to compare the results of right ventricular morphology and systolic function in three groups. Results (1)Right ventricular morphology indexes: right atrium upper and lower diameter((56.8±4.0) mm), right atrium left and right diameter((49.2±3.3) mm), right ventricle basal segment inner diameter((43.7±2.5) mm), right ventricle medial diameter((41.7±3.9) mm), right ventricle long axis distance((73.4±6.2) mm), sternum sidelines right ventricular outflow tract proximal end diameter((37.8±2.4) mm), short axis view right ventricular outflow tract distal internal diameter((33.6±2.1) mm), main pulmonary artery internal diameter((30.5±2.5)mm), right ventricle end diastolic area((31.6±1.8) cm2), right ventricle end systolic area((19.0±2.7) cm2)in group B were higher than those in group A((46.2±3.1) mm, (40.4±2.8) mm, (34.6±2.2) mm, (32.5±2.6) mm, (65.1±4.7) mm, (30.2±2.0) mm, (29.4±1.8) mm, (23.0±1.6) mm, (22.5±1.1) cm2, (11.6±1.2) cm2)and control group((45.3±2.6) mm, (39.5±1.7) mm, (34.0±1.9) mm, (31.8±2.0) mm, (63.2±3.8) mm, (29.6±1.7) mm, (28.9±1.5) mm, (22.4±1.4) mm, (22.1±1.0) cm2, (11.3±0.9) cm2), (F=140.26, 147.47, 223.08, 130.46, 43.56, 183.33, 74.71, 209.94, 587.99, 221.34, all P<0.01 ). (2)Right ventricle contractile function indexes : right ventricular area change rate((40.1±1.6)%), three tricuspid ring systolic displacement((2.2±0.2) cm), tricuspid valve peak systolic flow velocity((13.8±0.9) cm/s)in group B were lower than those in group A((46.3±1.7)%, (2.5±0.3) cm, (16.7±1.2) cm/s)and control group((46.8±1.5)%, (2.6±0.3) cm, (17.2±1.4) cm/s), the difference was statistically significant(F=200.81, 21.86, 88.85, all P<0.01 ). Conclusion Children with congenital heart disease associated pulmonary hypertension have right ventricle morphological changes and right ventricular systolic function decreasing.Right ventricular morphological examination has important clinical value. Key words: Congenital heart disease associated pulmonary hypertension; Right ventricular morphology; Children

2530 An Unusual Cause of Abdominal Pain From Salmonella enteritidis (SE): Guess Where the Bug Was?

INTRODUCTION: Aortitis, an inflammatory entity with high mortality that is usually due to a rheumatologic etiology; however, an infectious etiology is sometimes the cause. We present a rare case of aortitis secondary to Salmonella septicemia treated with 6 weeks of antibiotics. Endovascular surgical repair (EVAR) with antibiotics (abx) is the preferred treatment. CASE DESCRIPTION/METHODS: A 76 year-old male with HTN, DM and CAD s/p CABG 3 months prior, presented to the ED c/o 7-day hx of suprapubic abdominal pain radiating to the lower quadrants and lower back, associated with fever, chills, night sweats, and chest pain. There was no recent history of a diarrheal illness. VS: T 101 F, BP 100/60, RR 18 and pulse of 100. PE revealed costochondral erythema and tenderness, as well as manubrial and suprapubic tenderness. Labs showed WBC 31000, ESR 100, CRP 150, CT abdomen revealed perineural fibrosis of the aorta just above the ostium of the IMA; the presence of air pockets was concerning for infectious aortitis. Patient refused surgery. Blood C&amp;S were sent and patient was started on IV Cefipime, Linezolid and metronidazole. Sternal osteomyelitis was suspected. Bone scan revealed increased uptake in the region of the manubrium and upper body of the sternum. CTA confirmed aortitis. Blood C&amp;S and sternal biopsy grew SE and abx were switched to IV ceftriaxone for 6 weeks. There was clinical and radiographic improvement without complications. DISCUSSION: Salmonella aortitis carries a high mortality even with best treatment options, making prompt diagnosis crucial for survival. Risk factors for Salmonella aortitis include vascular pathologies, CAD, HTN, DM, immunosuppression, seronegative C2 Infections, rheumatological diseases and hematological malignancies. The best treatment for infectious aortitis is EVAR with long-term abx. Treatment with abx alone is controversial; however, their use is the mainstay of therapy. Review of literature revealed that patients treated solely with abx without surgery did not survive. Duration of abx is also controversial with some experts suggesting lifelong treatment. In this case, the patient refused surgery and received abx for 6 weeks only, with resultant clinical and radiological remission.

A Technique for 360-Degree Rigid Sternal Fixation with Sternal Plates and Wire Cerclage

Sternal instability after cardiac surgery can lead to poor bony healing, as well as deep sternal wound infections and mediastinitis. Rigid plate fixation is associated with greater stability and fewer complications compared with wire cerclage, however, rigid plate fixation alone lacks posterior stability of the sternum and may be less effective in morbidly obese or osteoporotic patients. This article describes a surgical technique of combined rigid plate fixation and wire cerclage that provides 360-degree stabilization for sternotomies in high-risk patients. We employed this technique in 40 patients with no incidence of deep sternal wound infection.

Sternal elements of early dinosaurs fill a critical gap in the evolution of the sternum in Avemetatarsalia (Reptilia: Archosauria)

ABSTRACTThe sternum is a functionally important but poorly understood component of the pectoral girdle in both living and extinct dinosaurs. When ossified, the dinosaur sternum consists of paired plates situated just posterior to the clavicles and scapulocoracoid. In Avialae, the sternal plates are fused at the midline to form a single element, aiding in powered flight. Our understanding of the early evolutionary history of the theropod sternum is complicated by a lack of fossil material, especially outside Maniraptoriformes, both because of taphonomic biases and incomplete ossification. Here, we report the oldest-known dinosaur sternal plates from the Late Triassic taxon Tawa hallae recovered from the Hayden Quarry at Ghost Ranch, New Mexico, as well as an isolated sternal plate from just south of Petrified Forest National Park, Arizona. These specimens expand the fossil record and allow for reconstruction of early theropod sternal musculature. They bear morphological features that are surprisingly similar to sternal traits in avialans, including a sternocoracoidal process, costal processes, and possible homologs to the ‘coracoid facet’ and pila coracoidea. The presence of these features in T. hallae pushes their appearance back to the Late Triassic, well before the development of the modern avian sternum. The variable distribution of sternal character states across avemetatarsalians was previously recognized in later Cretaceous avialans and can now be shown to also characterize the early evolution of the theropod sternum.

(22) Primary sternal osteomyelitis in a 2-year-old infant with an inferior sternal cleft

Introduction Primary osteomyelitis of the sternum is rare in the pediatric population. A literature review of all 78 published cases found no sternal malformations among those diagnosed [1]. We present the first case to our knowledge of a 2-year-old infant with an inferior sternal cleft that developed sternal osteomyelitis. Case Report A 2-year-old infant presents with fever, difficulty breathing and new onset rash. He is febrile to 38.6 O C with a respiratory rate of 40 breaths/min and a heart rate of 180 beats/min. He is an ill-appearing infant in respiratory distress with focal crackles heard in the …

Bone Teaser: A rare case of primary sternal osteomyelitis in a pediatric patient

Introduction Primary sternal osteomyelitis (PSO) in the pediatric population is exceedingly rare with no more than 74 cases reported thus far in the literature, including the pre antibiotic era. We report an interesting case of osteomyelitis in a female teenager with no known prior inciting event or risk factors but bone biopsy with culture, confirmed acute and chronic sternal osteomyelitis positive for methicillin-resistant Staphylococcus aureus (MRSA). Case report A 13-year-old girl with no significant past medical history presented to the emergency department with mild central chest pain, fever and …

Surgical outcomes of sternal rigid plate fixation from 2005 to 2016 using the American College of Surgeons-National Surgical Quality Improvement Program database.

BackgroundSternal rigid plate fixation (RPF) has been adopted in recent years in high-risk cases to reduce complications associated with steel wire cerclage, the traditional approach to sternal closure. While sternal RPF has been associated with lower complication rates than wire cerclage, it has its own complication profile that requires evaluation, necessitating a critical examination from a national perspective. This study will report the outcomes and associated risk factors of sternal RPF using a national database.MethodsPatients undergoing sternal RPF from 2005 to 2016 in the American College of Surgeons-National Surgical Quality Improvement Program were identified. Demographics, perioperative information, and complication rates were reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications.ResultsThere were 381 patient cases of RPF identified. The most common complications included bleeding (28.9%), mechanical ventilation >48 hours (16.5%), and reoperation/readmission (15.2%). Top risk factors for complications included dyspnea (odds ratio [OR], 2.672; P<0.001), nonelective procedure (OR, 2.164; P=0.010), congestive heart failure (OR, 2.152; P=0.048), open wound (OR, 1.977; P=0.024), and operating time (OR, 1.005; P<0.001).ConclusionsSternal RPF is associated with increased rates of three primary complications: blood loss requiring transfusion, ventilation >48 hours, and reoperation/readmission, each of which affected over 15% of the study population. Smokers remain at an increased risk for surgical site infection and sternal dehiscence despite RPF’s purported benefit to minimize these outcomes. Complications of primary versus delayed sternal RPF are roughly equivalent, but individual patients may perform better with one versus the other based on identified risk factors.

Pectus excavatum in adolescents and children: the Nuss technique

Pectus excavatum (PE) is also known as funnel or sunken chest. PE is the most common type of chest wall malformation, indeed occurs in about 1 of 300–400 births with a male predominance (M:F =3:1). It is featured of a depression of the body of the sternum and in association abnormalities of the costal cartilages. The aspect of the defect variant from mild to very severe. PE is frequently asymptomatic during childhood, but symptoms like easy tiredness and decreased hardiness often appear when patients become teenager or are involved in competitive sports. Surgical correction for PE has become rifer thanks to development of the mini-invasive repair (MIRPE), described for the first time by Nuss in 1989. MIRPE consists in a thoracoscopic fixing of at least one metal bar, which is maintained in the chest at least 2 years.