Artikel
Methods of anterior chest wall stabilisation depending on defect severity
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Autoren
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Maitham Sultan
- Klinik für Unfallchirurgie, Zentrum für Plastische und Wiederherstellungschirurgie, Universitätsklinikum Regensburg
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Sebastian Gehmert
- Klinik für Unfallchirurgie, Zentrum für Plastische und Wiederherstellungschirurgie, Universitätsklinikum Regensburg
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Mulyadi Hidayat
- Klinik für Unfallchirurgie, Zentrum für Plastische und Wiederherstellungschirurgie, Universitätsklinikum Regensburg
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Lukas Prantl
- Klinik für Unfallchirurgie, Zentrum für Plastische und Wiederherstellungschirurgie, Universitätsklinikum Regensburg
| Veröffentlicht: | 27. September 2011 |
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Gliederung
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Introduction: Partial or complete resection of an infected sternum after cardiac surgery results in wound defect and sternum instability requiring reconstruction. The most common treatment is stabilization with stainless-steel. However, the defected sternum remains at high risk for subsequent instability and no recommendation exist for sternum reconstruction based on a defect severity classification. In this study we aimed to identify appropriate method of sternum stabilisation depending on instability and soft tissue defect.
Materials and methods: In total, 27 patients with partial or total loss of the sternum with tissue defects after persisted infection were included in this study. The mean age was 65 years (range,60-70) and all patients received sternum reconstruction depending on the stability of the thoracic wall with. The sternum defects were classified in 3 groups: Intact manubrium and sternum body defect <1cm (group A), manubrium defect <2cm and sternum body defect <1cm (group B), total sternum defect (group C). Following reconstruction methods were used: Transverse Titanum plates (n=12), pectoralis flap (n=5), latissimus dorsi flap (n=4), latissimus dorsi flap combine with Transverse(Titanum) Plates (n=3) and osteocutaneous parascapular free flaps in combination with transverse titanium plates (n=3).
Results: All sternum reconstructions were successful with no recurrent infection in a follow up period of 3 years. Stable wound coverage was achieved in all patients and postoperative stability was obtained even for patients with complete loss of the sternum. For patients with an osteocutaneous parascapular free flap the plates were removed step by step after 1 and 2 years.
Conclusions: Our findings suggest that sternal plates achieved immediate stability in all cases. Stable long term wound coverage with obliteration of the dead space is possible in all patients with different sternum defect classification. The osteocutaneous parascapular flap is rigid enough to support and provide a sufficient long term stability of the thoracic wall after complete sternum loss.
