Reconstruction of Chronic Aseptic Sternal Pseudoarthrosis after Median Sternotomy: Initial Experience with the Ley Prosthesis

Abstract

It has previously been reported that the Ley prosthesis, a 0.5-mm-thick titanium alloy plate designed for reconstruction and stabilization of the unstable sternotomy, leads to shorter hospital stay and reduces the need for further surgical procedures in patients with postoperative mediastinitis after open heart surgery. We report our initial experience with the Ley prosthesis in patients with chronic aseptic sternotomy dehiscence. The study included 6 male patients (age 42-80 years) with opiate-derivate-dependent intractable pain and significantly reduced quality of life caused by noninfected sternal pseudoarthrosis and unstable sternotomy with large sternal bone tissue deficit. Four of the patients had undergone various surgical fixation procedures 8 days to 12 months after the primary operation. The patients were treated with reconstruction and stabilization of the sternum with the Ley prosthesis 10 to 40 months after the primary operation. In 1 patient bone transplantation was used. No immediate peri- or postoperative complications were observed, and all patients were discharged 4 to 11 days after surgery. One patient who received a bone transplant developed wound infection, and the prosthesis was removed 5 weeks after implantation. At 6-month follow-up all sternotomies were found stable, and patients reported that pain had decreased and quality of life was significantly improved. Our results demonstrate that the Ley prosthesis can be safely and efficiently used for the reconstruction and stabilization of the sternum in patients with intractable pain caused by noninfected postoperative sternal dehiscence and large sternal bone tissue deficit.

Deep Sternal Wound Complications: An Overview of Old and new Therapeutic Options

“…A few plates including horizontal titanium plates (Synthes GmbH, Oberdorf, Switzerland), the SternaLock (Biomet Microfixation Inc., Jacksonville, FL), and the Sternal Talon (KLS Martin Group, Tuttlingen, Germany) have been devised, some of which can be unlocked in case of emergency situations. [42][43][44] The Strasbourg Thoracic Osteosyntheses System (STRATOS) consists of rib clips with different angulations and connecting bars with adjustable length (MedXpert, Heitersheim, Germany). 45 All these systems serve the purpose well but are not absolutely necessary, as standard trauma plates can be used as well in most instances.…”