Sternal Reconstruction with Titanium Prosthesis for Complicated Sternal Dehiscence with Right Ventricle Herniation
Luís Alexandre Lourenço Graça1, Rita Lopes1, Carlos Branco1
1Serviço de Cirurgia Cardiotorácica, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
Abstract:
Sternal wound dehiscence after cardiac surgery is usually accompanied by a high morbidity and mortality rate. When sternal rewiring fails, rigid fixation systems may be used for sternal reconstruction. We report a case involving a female patient with multiple risk factors for sternal dehiscence who underwent a coronary artery bypass graft procedure. Postoperatively, she experienced sternal dehiscence that necessitated primary rewiring. Despite the surgical intervention and clinical optimization, the sternal wound dehiscence recurred. The patient experienced severe chest pain and thoracic instability, presenting with complete non-union of the sternal segments and right ventricular protrusion. Given the symptoms and the risk of both direct and indirect trauma to the heart, the multidisciplinary team opted to reinforce the anterior chest wall with a pre-planned titanium prosthesis to provide protection and stability. This report highlights the advantages of a comprehensive strategy for managing repeated sternal dehiscence.
