Postoperative transverse sternal nonunion with a chest wall defect managed by a tibial locking plate and a Gore-Tex
Tomaz Malovrh1,2, Tomaz Stupnik3, Boris Podobnik4
1Department of Traumatology, University Medical Centre Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia. tomaz.malovrh@mf.uni-lj.si.
Background:
Transverse sternal nonunion is a rare but disabling complication of chest trauma or a transverse sternotomy. Fixation methods, mainly used to manage the more common longitudinal sternal nonunion, often fail, leaving the surgical treatment of transverse nonunion to be a challenge.
Case Presentation:
We present a case of a highly-disabling, postoperative chest wall defect resulting from transverse sternal nonunion after a transverse thoracosternotomy (clamshell incision) and a concomitant rib resection. Following unsuccessful surgical attempts, the sternal nonunion was fixed with a tibial locking plate and bone grafted, while the post-rib resection chest defect was reconstructed with a Gore-Tex dual mesh membrane. Adequate chest stability was achieved, enabling complete healing of the sternal nonunion and the patient's complete recovery.
Conclusion:
We believe it is important to address both in the rare case of combined postoperative transverse sternal nonunion and the chest wall defect after rib resection. A good outcome was achieved in our patient by fixing the nonunion with an appropriately sized and shaped locking plate with bone grafting and covering the chest defect with a dual mesh membrane.
