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.