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Bilateral sequential lung transplantation without sternal division eliminates posttransplantation sternal
B F Meyers1, R S Sundaresan, T Guthrie
1Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo., USA.
The Journal of Thoracic and Cardiovascular Surgery
|January 27, 1999
Summary
Bilateral lung transplants can now be safely performed without dividing the sternum. This alternative surgical approach, bilateral anterolateral thoracotomy, avoids sternal healing complications common with the clamshell incision.
Area of Science:
- Thoracic Surgery
- Transplantation Surgery
- Surgical Innovation
Background:
- Bilateral sequential lung transplantation is typically performed using the "clamshell" incision (anterolateral thoracosternotomy).
- Sternal division in the clamshell incision is associated with wound healing complications like malunion, dehiscence, and osteomyelitis.
Purpose of the Study:
- To evaluate the efficacy and safety of an alternative surgical incision for bilateral sequential lung transplantation.
- To assess the utility of bilateral anterolateral thoracotomies without sternal division.
- To compare sternal wound complication rates between the novel approach and the traditional clamshell incision.
Main Methods:
- Retrospective review of 69 bilateral sequential lung transplantations performed between July 1996 and April 1998.
- Analysis of 52 cases utilizing bilateral anterolateral thoracotomies without initial sternal division.
- Comparison with a historical control group of 50 patients who underwent transplantation with a full clamshell incision.
Main Results:
- No sternal wound healing complications were observed in 50 patients who did not undergo sternal division.
- Two patients required emergency sternal division for bleeding control; 11 others underwent elective cardiopulmonary bypass without sternal division.
- A historical control group showed a 34% rate of sternal healing complications following clamshell incision.
Conclusions:
- Bilateral anterolateral thoracotomy without sternal division is a safe and effective alternative for lung transplantation.
- This approach provides adequate surgical exposure while mitigating risks associated with sternal healing.
- The modified technique successfully avoids sternal complications seen with the traditional clamshell incision.