Thorac Cardiovasc Surg 2011; 59(1): 30-33
DOI: 10.1055/s-0030-1250390
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Sternal Plate Closure: Indications, Surgical Procedure and Follow-up

A. Plass1 , M. Y. Emmert1 , M. Pilsl1 , S. P. Salzberg1 , M. Genoni2 , V. Falk1 , J. Grunenfelder1
  • 1Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
  • 2Heart Center, Triemli City Hospital, Zurich, Switzerland
Further Information

Publication History

received April 21, 2010

Publication Date:
17 January 2011 (online)

Abstract

Objectives: Titanium plate osteosynthesis (Synthes) is an alternative option for sternal closure. The indications and time point of application are still debated. This study investigated the application and feasibility of this technique after median sternotomy. Methods: Forty-one patients (29 M/12F, mean age 63 ± 17 years) received the plate system for complicated sternal conditions. Indications, intraoperative course and postoperative follow-up were assessed. Results: Sternal deformity was present in 5 % (2/41), sternal fractures in 17 % (7/41), bone defect in 12 % (5/41), wire loosening in 39 % (16/41) and pseudoarthrosis in 27 % (11/41). 54 % (22/41) of patients showed concomitant sternal infection. Two intraoperative complications were noted: mammary artery injury (1 patient), pleural injury (1 patient). At discharge the patients reported no pain (90 %, 37/41) or only occasional discomfort (10 %, 4/41). Postoperative complications were subcutaneous hematoma in 12 % (5/41), seroma in 12 % (5/41) and sternal reinfection in 7 % (3/41). 12 % (5/41) showed occasional discomfort and 7 % (3/41) had persistent pain leading to plate removal. Conclusion: The Titanium Sternal Fixation System is comfortable and easy to use. It can be used to treat a wide spectrum of indications, especially for pseudoarthrosis, an entity which has not yet received sufficient attention.

References

  • 1 Cohen D J, Griffin L V. A biomechanical comparison of three sternotomy closure techniques.  Ann Thorac Surg. 2002;  732 563-568
  • 2 Losanoff J E, Jones J W, Richman B W. Primary closure of median sternotomy: techniques and principles.  Cardiovasc Surg. 2002;  102 102-110
  • 3 Lu J C, Grayson A D, Jha P et al. Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery.  Eur J Cardiothorac Surg. 2003;  236 943-949
  • 4 Schimmer C, Reents W, Berneder S et al. Prevention of sternal dehiscence and infection in high-risk patients: a prospective randomized multicenter trial.  Ann Thorac Surg. 2008;  866 1897-1904
  • 5 Baril Y, Brailovski V, Chartrand M et al. Median sternotomy: comparative testing of braided superelastic and monofilament stainless steel sternal sutures.  Proc Inst Mech Eng H. 2009;  223 (3) 363-374
  • 6 Negri A, Manfredi J, Terrini A et al. Prospective evaluation of a new sternal closure method with thermoreactive clips.  Eur J Cardiothorac Surg. 2002;  224 571-575
  • 7 Zeitani J, Penta de Peppo A, Bianco A et al. Performance of a novel sternal synthesis device after median and faulty sternotomy: mechanical test and early clinical experience.  Ann Thorac Surg. 2008;  851 287-293
  • 8 Plass A, Grunenfelder J, Reuthebuch O et al. New transverse plate fixation system for complicated sternal wound infection after median sternotomy.  Ann Thorac Surg. 2007;  833 1210-1212
  • 9 Voss B, Bauernschmitt R, Will A et al. Sternal reconstruction with titanium plates in complicated sternal dehiscence.  Eur J Cardiothorac Surg. 2008;  341 139-145
  • 10 Cicilioni Jr O J, Stieg 3rd F H, Papanicolaou G. Sternal wound reconstruction with transverse plate fixation.  Plast Reconstr Surg. 2005;  115 (5) 1297-1303
  • 11 Plass A, Grunenfelder J, Pretre R et al. Titanium plate osteosynthesis for the correction of severe sternal deformity in a 13-year-old boy.  Interact Cardiovasc Thorac Surg. 2008;  75 935-937

Dr. Andre Plass, MD

Clinic for Cardiovascular Surgery
University Hospital Zurich

Raemistr. 100

8032 Zurich

Switzerland

Phone: +41 4 42 55 11 11

Fax: +41 4 42 55 11 11

Email: andre.plass@usz.ch