Secondary Sternal Closure With Titanium Plate Fixation After Bilateral Lung Transplantation
Flávia Fiuza de Andrade Vale1, Samuel Lucas Dos Santos1, Flavio Pola Dos Reis1
1Department of Cardiopneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (InCor-HCFMUSP), São Paulo, Brazil.
Transplantation Proceedings
|July 29, 2026
Summary
Rigid titanium plate fixation effectively manages sternal complications after bilateral lung transplants performed with clamshell incisions. This method offers a safe and successful alternative to traditional wire closure, reducing sternal issues.
Area of Science:
- Thoracic surgery
- Transplantation immunology
- Biomaterials engineering
Background:
- Transverse thoracosternotomy (clamshell incision) is vital for bilateral lung transplantation but carries a high risk of sternal complications.
- Conventional stainless steel wire closure has a 20%-40% complication rate, necessitating alternative methods.
- This study investigates a rigid titanium fixation system for secondary sternal closure.
Purpose of the Study:
- To evaluate the safety and efficacy of rigid titanium plate fixation for secondary sternal closure.
- To compare outcomes of titanium fixation versus conventional wire closure for sternal complications.
- To assess the impact of titanium fixation on reducing clamshell incision-related sternal complications.
Main Methods:
- Retrospective, single-center study of 131 bilateral lung transplantations (January 2020 - December 2024).
- Surgical access via clamshell incision with transverse sternotomy.
- Primary closure with stainless steel wires; secondary closure with rigid titanium fixation for complications.
Main Results:
- Seven patients required reoperation for sternal complications (osteomyelitis, instability, pain).
- All patients undergoing secondary closure with titanium fixation achieved successful sternal realignment and symptom resolution.
- No fixation-related complications were observed with the titanium system.
Conclusions:
- Rigid titanium plate fixation is a safe and effective strategy for secondary sternal closure.
- This method shows promise in reducing sternal complications associated with clamshell incisions in lung transplantation.
- Titanium fixation offers a superior alternative for managing sternal complications post-bilateral lung transplant.
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