Secondary Sternal Closure With Titanium Plate Fixation After Bilateral Lung Transplantation

Transverse thoracosternotomy (clamshell incision) provides wide exposure of thoracic anatomical structures and is commonly used in bilateral lung transplantation. However, it is associated with a significant risk of mechanical sternal complications. Conventional closure with stainless steel wires has reported complication rates of 20%-40%, prompting the development of alternative sternal closure strategies.

This retrospective, single-center study included patients who underwent bilateral lung transplantation between January 2020 and December 2024. A total of 131 transplants were performed, 7 patients required reoperation for sternal complications. In all cases, surgical access was obtained via a clamshell incision with transverse sternotomy. Primary sternal closure was performed using 3 interrupted stainless steel wire sutures. In cases of sternal complications, secondary closure was achieved using a rigid titanium fixation system. Demographic data, clinical characteristics, perioperative variables, and outcomes were analyzed RESULTS: Only 1 patient had pre-transplant colonization. All donor cultures were positive, with Staphylococcus aureus isolated in 6 cases. 3 patients required extracorporeal support, 2 of whom were listed under high-urgency status; 1 required intensive care with an open chest on ECMO. Four patients were reoperated on for sternal osteomyelitis, and 3 for mechanical instability or persistent pain. All patients achieved successful sternal realignment and symptom resolution, with no fixation-related complications.

Rigid titanium plate fixation is a safe and effective option for secondary sternal closure after bilateral lung transplantation and represents a promising strategy to reduce clamshell-related sternal complications.