Secondary sternal closure in high risk patients with a Titanium Sternal Fixation System after cardiac surgery

Objectives: The wire sternal fixation after previously medial sternotomy is a standardized procedure in cardiac surgery. In some cases a sternal dehiscence occurs, that can be complicated with an extensive wound infection leading to excessive surgery and re-fixation with sternal wires. By previously operated patients a conventional method of the sternal re-fixation is associated with additional risks of the bleeding or structure damage. An alternative method of the save sternal re-fixation is an osteosynthesis with a Titanium Sternal Fixation System, manufactured by Synthes.

Methods and results: Currently, we describe an alternative method of sternal re-fixation with Titanium Sternal Fixation System. Six patients, who had suffered from the sternal dehiscence with deep wound infection after cardiac surgery, were treated with the new titanium plate fixation system. Before the sternal osteosynthesis the wound infection was treated by vacuum assisted closure therapy. Thereafter a sternal osteosynthesis was electively performed without dissecting of the retrosternal space. The postoperative period was uneventful in all cases. All of the patients could be discharged from the hospital in good condition. There was no re-infection or mechanical instability.

Conclusion: The Titanium Sternal Fixation System shows to be safe and can be applied for rigid sternal re-fixation in high risk patients. Moreover a stable thoracic construction can be reached, which is a basic condition for the successful wound therapy by the deep sternal wound infection.