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Title: Trans-Sternal Titanium Fixation Bars: An initial experience with 20 patients
Abstract: A sternal rigid-fixation system is described for use in primary and secondary closure in the face of dehiscence, infection and damaged old sternotomies. Patient selection included “high risk” obese patients, severe COPD and early dehiscence over fresh bypass grafts. Of the 20 patients, two died within thirty days of surgery, two eventually underwent plate removal for chronic infection, three went on to heal with VAC therapy and titanium bar retention, 15 patients went on to primary healing and discharge within one week of surgery and one patient had the bars placed as a “permanent temporary” bridge to allow chest closure without the risk of tamponade secondary to cardiac edema, he went on to primary healing.
Conclusions: (1) Rigid sternal fixation can be achieved in all settings, (2) “contaminated” wounds are not a contra-indication, (3) utilizing VAC therapy, healing may be achieved over exposed bars in secondary superficial infections, (4) sternal bone presence is not essential for rigid fixation as rib anchorage is sufficient, (5) the sternum may be rapidly re-opened, even at bedside, by easily removing the locking pins holding the bars together, (6) mediastinal compression during chest closure is adjustable with the spanning bars, (7) early pain-free hospital discharge is typical and (8) the decrease in hospitalization and the preservation and salvage of lives justifies the cost of the device and the difficult learning curve.