Complicated sternal dehiscence treated with the strasbourg thoracic osteosyntheses system (STRATOS) and the transposition of greater omentum: a case report

Abstract

Sternal dehiscence is a serious complication after cardiac surgery. Sternal refixation, performed by simple rewiring or techniqual modification of rewiring as described by Robicsek, can fail, overall when the bone quality is poor or the sternum is completely destroyed. The sternal closure systems, consisting of plates, screws or rib clips and titanium bars, have been recently introduced to treat the complicated sternal dehiscence. We describe for the first time the use of the Strasbourg Thoracic Osteosyntheses System (STRATOS) and the greater omentum, to treat a complicated sternal dehiscence, causing chest pain and respiratory failure.

Caudal Mediastinal Paraesophageal Abscesses in 7 Dogs

“…In people, wide mediastinal debridement and chest drainage is the treatment of choice for mediastinal abscessation . Although described in the treatment of sternal infection, omentalization is not reported for the treatment of mediastinal or pleural abscess. Recent reports describe abscess drainage by thoracoscopy and this would have been a potentially alternative method of managing our dogs.…”

Transomental Titanium Plates for Sternal Osteomyelitis in Cardiac Surgery

“…Several strategies have been recently proposed, ranging from chest plates that provide thoracic stability, 8 to more complex devices such as the Ley prosthesis that is made of a 0.5 mm thick titanium alloy plate shaped as a step ladder, which is flexible and adaptable to the sternal contour 9 . More recently, a novel device has been proposed to achieve chest wall stability in case of extensive resection of the ribs for disruptive malignancies of the thoracic wall: the Stratos System, 10 which consists of titanium bars that are anchored to the ribs, ensuring chest wall stability. Titanium has appreciable structural characteristics (resistance and lifespan) and less interference with computed tomography that allows more accurate three‐dimensional reconstructions; moreover, as it is nonferromagnetic, it can be used safely with magnetic resonance imaging.…”

“…Titanium has appreciable structural characteristics (resistance and lifespan) and less interference with computed tomography that allows more accurate three‐dimensional reconstructions; moreover, as it is nonferromagnetic, it can be used safely with magnetic resonance imaging. Recently, the use of this device has been proposed in cases of mediastinitis with extensive tissue resection to achieve chest wall stability 10 . Each implant consists of two rib clips united by a connecting bar.…”

“…Recently, the use of this device has been proposed in cases of mediastinitis with extensive tissue resection to achieve chest wall stability. 10 Each implant consists of two rib clips united by a connecting bar. The three different angulations of the rib clips and the adjustable length of the connecting bar allows this system to be used for all anatomical variations.…”

Early Repair of Sternal Instability Prevents Mediastinitis

“…It is a devastating infectious complication, involving the mediastinal space of the chest. The literature reports mediastinitis rates following cardiac surgery of between 0.5% and 5%, with a mortality rate as high as 40% [3,4].…”