Objective To investigate surgical strategies using bilateral pectoralis major muscle flaps for the treatment of sternal dehiscence after cardiac surgery. Methods From May 2005 to October 2010，21 patients with sternal dehiscence, sternal osteomyelitis and mediastinitis after cardiac surgery were admitted to Beijing An Zhen Hospital of Capital Medical University. There were 13 male patients and 8 female patients with their age of 53-72 （64.5±7.8） years. There were 19 patients after coronary artery bypass grafting （CABG） and 2 patients after heart valve replacement. The non-viable and necrotic bones were debrided and sternal wires partially or completely removed. The sternal origins of pectoralis major were released on both sides. The pectoralis major muscle flaps were tensionlessly sutured across medially over the sternal defect. Multiple suction drains were placed and removed in due time. The skin was intermittently closed. Results All the pectoralis major muscle flaps lived well after surgery，and all the patients were discharged in 2 weeks after surgery. Twenty patients were discharged with complete wound closure，and 1 patient had wound fistula and infection after removal of suction drains that was healed after another surgery to resect the wound fistula. During 6 month follow-up，sternal wound healed well in all the patients with normal thoracic appearance，and none of the patients had abnormal respiratory movement, infection recurrence or persistent infection. Conclusion Bilateral pectoralis major muscle flap technique is a positive and efficient surgical strategy for the treatment of refractory sternal dehiscence after cardiac surgery.
Objective To investigate surgical indications，techniques，safety and clinical outcomes of minimallyinvasive sternal lowering operation for the treatment of pectus carinatum （PC）. Methods Clinical data of 40 PC patientswho underwent minimal invasive sternal lowering operation in Xinhua Hospital，School of Medicine，Shanghai Jiao Tong University from July 2009 to August 2012 were retrospectively analyzed. There were 39 male patients and 1 female patientwith their average age of 14.5 （12-22）years. All the patients underwent their surgical correction for the first time，and their chest deformity were characterized by a significant protrusion of the sternum and ribs including 21 symmetric and 19 asymmetric protrusions. Preoperative evaluation included electrocardiogram，CT scan of the chest，echocardiogram and pulmonary function test. Preoperative mean Haller index was 1.91±0.23. Sixteen patients had mild restrictive ventilatory disorder. Allthe patients received minimally invasive sternal lowering operation with a curved Nuss steel bar. Aggravating activities wererestricted within 3 months postoperatively，and the steel bar was removed 2 years later. Results All the operations were completed successfully，and thoracic appearance was significantly improved after correction. All the patients and their relativeswere very satisfied with the corrective outcomes. The operation time was 65-115 （82.0±15.6）minutes and average intraop-erative blood loss was less than 10 ml. Postoperative hospital stay was 3-5 （3.5±0.8） days. Postoperative Haller index was2.39±0.17，which was significantly higher than preoperative Haller index （P＜0.01） . Postoperative complications included wound infection in 2 patients，pneumothorax in 1 patient （cured by closed thoracostomy），subcutaneous effusion in 3 patients，and persistent pain （longer than 14 days） in 2 patients. There was no other serious postoperative complication. All the 40 patients were followed up for 3-36 months after discharge. A steel bars was removed ahead of schedule because of wound infection in one patient. Other steel bars were in normal position in 39 patients and there was no displacement of the steel bars or the stabilizers. Eight patients received removal of the steel bars without PC recurrence. Conclusion Juveniles with PC who have good chest wall compliance are the best candidates for minimally invasive sternal lowering operation which is an easy，safe，reliable，minimally invasive and esthetic procedure with satisfactory corrective outcomes.
Objective To study the reconstruction method and effectiveness of titanium plate and Teflon patch for the chest wall after resection of sternal tumors. Methods Between October 2006 and November 2009, 4 patients with sternal tumors were treated and the thoracic cages were reconstructed. There were 2 males and 2 females, aged 30-55 years. The patientswere admitted because of chest lump or pain. The sizes of palpable lump ranged from 4 cm × 3 cm to 10 cm × 8 cm. CT examination showed bone destruction. After sternal tumor resection, defect size ranged from 10 cm × 8 cm to 18 cm × 14 cm, and titanium plate and Teflon patch were used to repair and reconstruct the chest wall defect. Results The operations of the tumor resection and reconstruction of chest wall defect were successfully performed in 4 cases. Incisions healed by first intention with no abnormal breath, subcutaneous emphysema, pneumothorax, and infection. One case failed to be followed up after 6 months; 1 case died of intracranial hemorrhage; and 2 cases were followed up 1 and 4 years respectively without tumor recurrence. The chest wall had good remodel ing. No loosening and exposure of titanium plate, difficulty in breathing, chest distress, and chest pain were observed during followup. Conclusion Surgical resection of sternal tumors will cause large chest wall defect which can be repaired by titanium plate and Teflon patch because it had the advantages of easy operation, satisfactory remodel ing, and less compl ication.
Objective To evaluate the preliminary effect of using the sternal head of the sternocleidomastoid myocutaneous flap to reconstuct a defect in the maxillofacial region. Mathods From May 2004 to September 2006, 5 male patients aged 2334 underwent the reconstruction for the defect in the maxillofacial region by using the sternal head of the sternocleidomastoid myocutaneous flap. Their defects were caused by an infection of the face, an injection of medicine in the mother’s uterus or a scar or depressed abnormality left by an electric injury. The defects ranged in size from 5 cm×3 cm to 9 cm×6 cm. Results All the 5 sternocleidomastoid myocutaneous flaps survived, with a little necrosis of the epidermis because of the venous return disturbance, but 2-3 weeks after operation the necrosis healed spontaneously with just a little scar formation around the flap. One patient had weakness in the left shoulder after operation, which almost recovered 6 months after operation. The postoperative follow-up for 1-6 months revealed that 1 patient had a little fat and clumsy appearance in the flap pedicle, 1 patient had an obvious scar at the operation site, but the 2 patients still felt satisfaction. The other 3patients were satisfied with their good appearance at the operation sites. Conclusion The sternal head of the sternocleidomastoid myocutaneous flap can be designed with more flexibility compared with the entire sternocleidomastoid myocutaneous flap. It can provide an enough tissue mass for restoring the defect. The sternal head of the sternocleidomastoid myocutaneous flap is an ideal tissue flap for restoring defects in the maxillofacial region.
ectus exeavatum is the most common chest wall deformity. The impairment of cardiopulmonaryfunction, severe psychological injury and other complications will be caused by the deformity. ″TheSternal Turnover″and″ The Sternal Elevation″are respective difference in indications andcharacteristics to treatment of pectus exeavatum. Pectus excavatum deformity will be repaired with theproper procedure and postoperative treatment. Their exercise tolerance and cardiac function will alsobe impro...
ObjectiveTo summarize the experiences of surgical treatment of sternal dehiscence after cardiac surgery. MethodsFrom January 2011 to January 2014, 7 patients with sternal dehiscence after cardiac surgery were admitted to our hospital. There were 4 male patients and 3 females with an age of 35-72 (52.5±13.4) years old. Two patients accepted coronary artery bypass, 4 underwent mechanical valve replacement and 1 underwent Sun’s procedure. The necrotic bones were debrided and sternal wires completely removed. After the original wires were completely extracted, the infected tissues behind the sternum were removed. Part of the pectoralis major was released with free tension on both sides when suturing was carried out over the sternal defect. Negative pressure drainage tube was used for full drainage. ResultsAll the patients were discharged from hospital with very good recovery. The sternal wound was healing well with normal thoracic appearance, and none of the patients had recurrent infections. ConclusionsPatients with sternal dehiscence after cardiac surgical procedure should undergo surgical debridement. Stabilizing the sternum, rich blood supply and improvement of overall condition of the patients are very important for recovery.
ObjectiveTo define the classification of sternal wound complications after cardiac surgery and to explore the appropriate surgical treatment. MethodsBetween July 2008 and January 2014, 260 patients with sternal wound complications after cardiac surgery were treated. There were 124 males and 136 females, aged 11-75 years (mean, 49.5 years). The disease duration was 13-365 days (mean, 26.6 days) with a wound length of 1-25 cm (mean, 13.4 cm). The wounds were divided into type I (n=70), type Ⅱ (n=64), type Ⅲ (n=42), type IV (n=78), and type V (n=6) according to self-generated classification for sternal wound complications after cardiac surgery. After debridement, wounds of type I and type Ⅱ were repaired with local flap transplantation; wounds of type Ⅲ were repaired with local flap transplantation combined with butterfly sternal fixation (n=28), with bilateral pectoralis muscle flap combined with butterfly sternal fixation (n=11), and with bilateral pectoralis muscle flap (n=3); wounds of type IV were repaired with bilateral pectoralis muscle flap (n=65), rectus abdominis muscle flap (n=5), and pedicled omental flap (n=8); and wounds of type V were repaired with pedicled omental flap. ResultsAll the operations were successfully performed. Three patients died after pedicled omental flap repair, including 1 case of type IV and 2 cases of type V. The hospitalization time were 4-86 days (mean, 18.3 days). Primary wound healing was obtained in 248 cases (96.5%); poor healing occurred in 9 patients, which were cured after second surgery in 8 cases and after the third surgery in 1 case. ConclusionThe surgical treatment based on self-generated classification is appropriate to sternal wound complications after cardiac surgery. It can provide clinical evidence for the choice of subsequent operation.
Objective To evaluate the risk factors for sternal wound infections after various cardiac operations. Methods We retrospectively analyzed the clinical data of 2 924 consecutive patients (28% female) in our hospital from 2010 to 2014 year. Their median age was 69 years (interquartile range of 60 to 76 years). Procedures included isolated coronary artery bypass grafting (CABG), isolated valve repair or replacement, and valve procedures plus CABG. Results Sternal wound infection was detected in 110 (3.8%) patients among the 2 924 patients: 67 of 1 671 patients (4.0%) after CABG, 17 of 719 (2.4%) after valve operations, and 26 of 534 (4.9%) after valve+CABG operation. In the CABG patients, bilateral internal thoracic artery harvest procedure, operation time>300 minutes, diabetes, obesity, chronic obstructive pulmonary disease, and female were independent risk factors for sternal wound infection. In the valve operation patients, only revision for bleeding as an independent predictor for sternal infection. For combined valve plus CABG patients, revision for bleeding and operation time>300 minutes were independent risk factors for sternal infection. Conclusion Risk factors for sternal wound infections after cardiac operations vary with the type of surgical procedure. In patients undergoing valve operations or combined operations, procedure-related risk factors (revision for bleeding, operation time) independently predict infection. In patients undergoing CABG, not only procedure-related risk factors but also bilateral internal thoracic artery harvest and patient characteristics (diabetes, chronic obstructive pulmonary disease, obesity, female) are predictors of sternal wound infection. Preventive interventions may be justified according to the type of operation.
The sternum is the pivotal component of the thoracic cavity. It is connected with the clavicle and ribs on the upper part and both sides respectively, and plays an important role in protecting the stability of the chest wall. Sternal resection usually results in a large segmental chest wall defect that causes the chest wall to float and requires sternal reconstruction. This paper reports a 62 years male patient with thymic squamous cell carcinoma with sternal metastasis, who underwent thymotomy, sternal tumor resection and autologous lilum graft combined with sternal reconstruction by titanium plate after relevant examination was completed and surgical contraindications were eliminated. The patient was followed up for 6 months, the respiratory and motor functions were normal and the thoracic appearance was good.