Sternal reconstruction with titanium plates in complicated sternal dehiscence

Area of Science:

• Cardiothoracic Surgery
• Biomaterials Engineering
• Surgical Reconstruction

Background:

• Sternal dehiscence following median sternotomy presents significant challenges, particularly with multiple fractures or infection.
• Conventional sternal closure methods may fail in high-risk patients, necessitating advanced reconstruction techniques.

Purpose of the Study:

• To evaluate the efficacy and safety of titanium plate fixation for sternal reconstruction in patients with complicated sternal dehiscence.
• To compare the outcomes of transverse versus longitudinal titanium plating techniques.

Main Methods:

• A cohort of 15 patients with unstable thorax underwent sternal reconstruction using titanium plates.
• Two techniques were employed: transverse plating (Synthes Titanium Sternal Fixation System) in 6 patients and longitudinal plating (2.4mm Synthes locking reconstruction plates) in 9 patients.
• Infection cases involved debridement, antibiotics, and topical negative pressure therapy.

Main Results:

• Both plating techniques provided stable thoracic constructs postoperatively.
• Longitudinal plating required less operative time and muscle mobilization compared to transverse plating.
• Three patients (transverse group) experienced plate-related pain requiring removal; one non-study-related death occurred.

Conclusions:

• Titanium plate fixation is a viable and effective solution for complex sternal dehiscence.
• The longitudinal plating technique appears to be technically simpler and associated with a lower complication rate.