Combined thoracoplasty using titanium mesh implant in patients with total sternal instability following postoperative sternomediastinitis

• Published in: Hirurgija (Moskva) no. 11; p. 13
• Main Authors: Pechetov, A A, Revishvili, A Sh, Esakov, Yu S, Makov, M A, Volchansky, D A, Khlan, T N
• Format: Journal Article
• Language: Russian
• Published: Russia (Federation) 2019
• Subjects: Aged; Female; Follow-Up Studies; Humans; Male; Mediastinitis - etiology; Mediastinitis - surgery; Middle Aged; Osteomyelitis - etiology; Osteomyelitis - surgery; Postoperative Complications - surgery; Prosthesis Implantation; Recurrence; Retrospective Studies; Sternum - surgery; Surgical Mesh; Surgical Wound Infection - surgery; Thoracoplasty - methods; Titanium; sternal wound infection; sternomediastinitis; titanium mesh implant; thoracoplasty; sternal osteomyelitis
• ISSN: 0023-1207
• DOI: 10.17116/hirurgia201911113

To analyze the results of chest wall reconstruction with titanium mesh implant in patients with total sternal instability following postoperative sternomediastinitis. There were 100 patients with total sternal instability for the period from January 2016 to December 2018. Median of age was 62 (58; 68) years. Male/female ratio was 82/18. All patients were treated in accordance with standardized protocol. Postoperative complications were assessed using Clavien-Dindo scale. Staged surgical treatment including one or more debridement procedures before the final thoracoplasty was performed in 62 (62%) out of 100 patients. Aseptic sternal instability was observed in 38 patients. Follow-up period ranged from 3 weeks to 35 months after the final thoracoplasty. Complicated postoperative period occurred in 15 (15%) out of 100 patients (95% CI 9.3-23.3). One patient died in 9 days after surgery from acute heart failure. Complications without need for redo surgery, postoperative wound suppuration and seroma were noted in 3 patients. Redo surgery was required in 11 patients due to postoperative wound suppuration, eventration after thoracoomentoplasty, intermuscular hematoma and delayed divergence of major pectoral muscles. Removal of mesh implant was performed in 1 out of 100 patient (95% CI 0.2-5.5) in 7 days after surgery due to suppuration. There was no recurrent sternal instability within 30 days. Anterior chest wall reconstruction using titanium mesh implant is an effective and safe procedure in patients with postoperative sternal instability following postoperative sternomediastinitis.