Multidisciplinary Surgery In Thoracic Wall Reconstruction For Sternal
Osteomyelitis
Abstract
Sternal osteomyelitis and dehisense are a common problem with an
incidence rate of 0.5% to 5.0% after major cardiac surgery. However,
the management of separation of the sternum in the patient’s thorax
remains a challenge for cardiac surgeons and thoracic surgeons using the
incision. After cardiac surgery, postop sternal dehiscence and
osteomyelitis was developed in the patient. The old steel wires were
removed and the sternum was resected due to long-term infection and
extensive deformation of the sternum. Pectoralis muscle flaps were
partially mobilized and adducted. The large defect was closed using a
large prolene patch. Proper sized transversal titanium plates were
selected. Due to the sternum bone was severely destroyed by infection,
longer transversal titanium plates were chosen to achieve thoracic
stability. Healthy tissues were detected on the ribs. A total of 4
titanium plates were placed intermittently. The plates were fixed to the
ribs with titanium locking screws. The pectoral muscle flaps adducted to
the plates by the plastic surgery team. A total of 3 drains were placed,
one in the mediastinum and two between the thoracic wall and muscle
structures.