Transverse sternal plating in secondary sternal reconstruction.

OBJECTIVES

Sternal instability after cardiac surgery occurs infrequently but can be challenging to manage. The most common treatment of mechanical sternal instability is operative rewiring. Transverse rib-to-rib stabilization with titanium plates designed for sternal fixation is a recent option. We evaluated the clinical utility of the transverse plating system in a cardiothoracic practice.

METHODS

We retrospectively reviewed our experience with transverse sternal plating using the Synthes titanium sternal plate system (Synthes CMF, Paoli, Pa) from June 2004 to June 2007.

RESULTS

There were 15 sternal reconstruction procedures performed in 14 patients using the transverse sternal plates. One patient required reoperation for sternal plate fracture. Indications for sternal plating were chronic sternal dehiscence in 9 procedures, acute sternal dehiscence in 3 procedures, previous mediastinitis and sternectomy in 2 procedures, and sternal plate fracture in 1 procedure. The initial cardiac operation was isolated coronary artery bypass in all patients. The mean age was 59 years (range, 51-68 years), all patients were men, 12 patients had a body mass index of greater than 30 kg/m(2) (range, 22-40 kg/m(2)), 9 patients were diabetic, 8 patients were active smokers, and 7 patients had chronic obstructive pulmonary disease. The mean follow-up period was 15.5 months (range, 3-33 months). All patients achieved sternal stability with minimal postoperative pain. Complications included infection requiring explantation in 1 patient, plate fracture in 1 patient, and seroma formation in 1 patient.

CONCLUSION

The transverse sternal plating system successfully achieved stability in all cases and is valuable in complex sternal reconstructions. Sternal plating is an effective alternative to wire closure in sternum with fractures, chronic and acute instability, or poor bone quality.