Sternal wound reconstruction with transverse plate fixation

Background: Although sternal wound infections and nonunions affect only a small percentage of patients undergoing median sternotomy, the morbidity, mortality, and expenses associated with them continue to make their treatment of great importance. Methods: The authors present a retrospective study of their experience using titanium plates for repair of 50 complicated sternal wounds. The cases reviewed include all cases performed by the primary and secondary authors between the years of 1998 and 2002. Synthes 2.4-mm locking reconstruction plates were used in transverse fixation across the sternum in con unction with simple bilateral pectoralis advancement flaps for repair of sternal wound dehiscence, osteomyelitis, and nonunion after median sternotomy. Results: All patients who received treatment were healed. All but one patient went on to complete bony union. Only one case was identified in which a patient developed recurrence of infection around a plate as a late complication 3.5 years later. There were no deaths. Conclusions: Transverse plate fixation of the sternum in con unction with simple bilateral pectoralis advancement flaps is a safe and effective means of treating complicated sternal wounds. The benefits of this procedure over standard muscle flap reconstruction include earlier extubation, a tension-free repair with faster and more reliable healing, and a simpler flap technique without the need for turning the pectoral muscle over or dividing it from its origin. The authors believe that this technique is safe and easy to perform and that it may become the standard for sternal reconstruction in the future.