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The author describes an operating guideline for local treatment in cases dealing with sternum surgery as part of bypass surgery and saphenous vein surgery in a post-anesthesia recuperation ward for patients having cardiac problems, trying to prevent and reduce the distinct local complications which can occur such as infection or dehiscence of a wound.
Experience in surgical treatment of 186 patients with funnel chest deformity (FCD) is generalized. With consideration for the great variety of the forms of deformity of the plastron, simple and complicated forms of FCD are distinguished. The simple forms include isolated, symmetrical, low (beginning from the level of the fourth rib) II-III degree deformities, the complicated forms include wide, II-III degree deformities beginning from the level of the second rib, and flat asymmetrical deformities. The use of a metal plate as a stabilizer in complicated forms of FCD is suggested. The optimal method of treatment in simple forms of the deformity is thoracoplasty with fixation of the sternum in the corrected position by means of a nitinol clip.
Hemangiopericytoma of the chest wall is a rare tumor. We describe a patient with malignant hemangiopericytoma of the sternum who was treated with primary surgical resection and discuss the clinical, radiographic, and histologic features of the case. Surgical resection is the primary mode of therapy. High-dose radiotherapy and chemotherapy with a doxorubicin hydrochloride-containing combination may be warranted in certain cases.
A 61-year-old male case, who was complicated with mediastinitis after coronary bypass surgery with left internal mammary artery, was reported. He was treated with open packing of gauze saturated with povidone iodine solution for 17 days, and thereafter pedicle transposition of great omentum with total excision of the sternum as a second procedure, was performed. His postoperative course was uneventful without any respiratory complication. From this experience, we concluded that omentum was very effective strategy in management of mediastinal infection following cardiac surgery.
A prospective study of the nosocomial infection rate in the Department of Cardiac Surgery of the Surgical Clinic (Charité) was done between January and December 1987. The investigation was performed computer aided. Data were recorded by an infection register. From 474 hospitalized operated patients 66 (14%) had some kind of nosocomial infection: at the first place wound infections with 5.1% (sternum osteomyelitis 2.1%), respiratory infections with 3.8% and infections of the urogenital system with 3.4%. The way of infection, selected predisposing and exposing factors, the microbacterial spectrum of wound infection, the antimicrobacterial chemotherapeutic strategy and surgical therapy are analyzed and demonstrated.
A newborn infant with bifid sternum and partial ectopia cordis is reported and the pertinent literature is briefly reviewed. Its successful surgical management is described. Early repair is recommended.
A method to prevent and treat sternum separation following open-heart surgery is presented. The procedure consists of passing parasternal continuous sutures placed alternatingly in front and behind the costal cartilages and then including them in the usual parasternal sutures.
A newborn with bifid sternum and early surgical management is reported.
Between 1980 and 1985 six cases of isolated fracture of the sternum were observed out of a total of 72 patients (8%) with traumatic lesions of the chest in road traffic accidents. This indicates the tendency for this type of fracture to increase. The study also demonstrated the possibility of associated cardiac or mediastinal lesions which may be overlooked or develop insiduously.
This article presents the case of a child with an unusual type of cleft sternum characterized by fusion superiorly between the clavicles and inferiorly at the xiphoid with wide intervening separation. The defect was successfully corrected at age 17 months by surgical closure of the cleft primarily, which had not been achieved previously in a patient at this late age.
An easy technique is presented for the treatment of simple transversal fractures of the sternum when loss of alignment of the fractured extremities occurs. This technique produces instant relief and will avoid open reduction and wiring in most instances of uncomplicated fractures.
46 sternums originating from 1-day- to 17-year-old children were injected with India ink and transparified. The intraosteal and medullary vasculature is described at different stages, as well as cartilage canals, vessels of the isolated ossification center, vessels of the ossification center connected with peripheral vascular structures or neighboring cartilage canals, and finally the transition to the adult pattern. With age, the centrifugal vascular distribution develops to a centripetal pattern.
A surgical approach to the repair of aortic arch aneurysm presenting through the sternum is described. A limited right anterior thoracotomy is made to gain access to the right and left atria. A vertical sternotomy is made only after profound core hypothermia has been achieved and the fibrillating left ventricle decompressed. The circulation is arrested and the patient exsanguinated during sternotomy, providing controlled conditions should the aneurysm be entered.
Primary surgical repair of a complete cleft sternum in a 31-day-old infant is reported. Early surgical repair is recommended because it is usually simple, achieves good results and primary repair is usually feasible. Alternative procedures are discussed and compared with primary repair. The literature is reviewed and a clinical classification of the anomaly is proposed.
A case of inflammatory pseudotumor of the sternum resulting from the application of polyurethane foam is discussed. The past use of polymers in bone repair is reviewed.
In a patient, suffering from a chondrosarcoma in the lower sternum, and having undergone radical tumor resection, we had to reconstruct the thoracic wall, the abdominal wall, and the diaphragm. This was done with autologous corium. We report on the advantages of this material and at the same time refer to that of a complete physiologic reconstruction of the diaphragmatic dome seems impossible if accompanied by defects of the thorax and the abdominal wall. Fitting a corset appears necessary as an external support.
A case of a one month-old girl with primary osteomyelitis of sternum is described. The presence of a positive blood culture to staphylococcus and the antecedent of respiratory physiotherapy are considered to be important etiologic factors. The proccess had a favorable evolution treated with antibiotics and drainage of subperiostal abscess.
Thirty-five patients were evaluated for possible postoperative sternal osteomyelitis by tomography. Frank bone destruction and severe demineralization were the only radiologic signs that helped to distinguish patients with sternal osteomyelitis from those with infections limited to soft tissues. We report a patient in whom sternal osteomyelitis was shown by computerized tomography (CT). This observation suggests that CT may provide added information, especially if the sternum is severely demineralized.