Late Complications of Chest Wall Reconstruction: Management of Painful Sternal Nonunion

Kyle J Chepla; Christopher J Salgado; Cathy J Tang; Samir Mardini; Karen K Evans

doi:10.1055/s-0031-1275176

Seminars in Plastic Surgery, Table of Contents

Semin Plast Surg 2011; 25(1): 098-108
DOI: 10.1055/s-0031-1275176

Late Complications of Chest Wall Reconstruction: Management of Painful Sternal Nonunion

Kyle J. Chepla¹ , Christopher J. Salgado² , Cathy J. Tang³ , Samir Mardini⁴ , Karen K. Evans⁵

¹Department of Plastic Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
²Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, Florida
³Department of Surgery, University of California San Francisco, San Francisco, California
⁴Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
⁵Georgetown University Medical Center, Washington, DC

Abstract

ABSTRACT

Although rare, sternal nonunion after median sternotomy or traumatic injury is associated with a high rate of morbidity. Pain and sternal clicking are two of the most common complaints and reasons these patients seek evaluation and treatment. Diagnosis of sternal nonunion is based on a thorough history and physical examination and can be confirmed with subsequent radiographic imaging. The treatment for symptomatic sternal nonunion requires stable fixation of the bony fragments and chest wall after the debridement of all nonviable bony and soft tissue by the cardiothoracic or reconstructive surgery team. Multiple fixation techniques have been described and incorporate a wide variety of materials including combinations of wires, cables, pins, bands, staples, and plates. Most recently, several new commercially available plating systems have demonstrated low recurrence and complication rates and resolution of the patient's symptoms on follow-up evaluation. Included in this review are three cases demonstrating the management of symptomatic sternal nonunion using these new techniques and review the history, diagnosis, risk factor, and classification, as well as several of the previously described fixation methods.

KEYWORDS

Sternum - nonunion - treatment - management

Full Text

References

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Christopher J SalgadoM.D.

Division of Plastic Surgery, University of Miami Miller School of Medicine

1611 NW 12th Avenue, ET 3019, Miami, FL 33136

Email: salgado_plastics@hotmail.com