Department of Traumatology, University Medical Centre Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia.
Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
J Cardiothorac Surg. 2021 Dec 6;16(1):345. doi: 10.1186/s13019-021-01730-5.
Transverse sternal nonunion is a rare but disabling complication of chest trauma or a transverse sternotomy. Fixation methods, mainly used to manage the more common longitudinal sternal nonunion, often fail, leaving the surgical treatment of transverse nonunion to be a challenge.
We present a case of a highly-disabling, postoperative chest wall defect resulting from transverse sternal nonunion after a transverse thoracosternotomy (clamshell incision) and a concomitant rib resection. Following unsuccessful surgical attempts, the sternal nonunion was fixed with a tibial locking plate and bone grafted, while the post-rib resection chest defect was reconstructed with a Gore-Tex dual mesh membrane. Adequate chest stability was achieved, enabling complete healing of the sternal nonunion and the patient's complete recovery.
We believe it is important to address both in the rare case of combined postoperative transverse sternal nonunion and the chest wall defect after rib resection. A good outcome was achieved in our patient by fixing the nonunion with an appropriately sized and shaped locking plate with bone grafting and covering the chest defect with a dual mesh membrane.
胸骨横断不愈合是胸部创伤或横形胸骨切开术后罕见但致残的并发症。固定方法主要用于治疗更常见的胸骨纵行不愈合，但往往失败，使得横断不愈合的手术治疗成为一个挑战。
我们报告了一例严重致残的胸壁缺损病例，该病例是由于横形开胸术后（蛤壳式切口）胸骨横断不愈合和同时切除肋骨所致。在不成功的手术尝试后，使用胫骨锁定板固定胸骨不愈合并用骨移植，同时用 Gore-Tex 双层网膜重建肋骨切除后的胸壁缺损。获得了足够的胸廓稳定性，使胸骨不愈合完全愈合，患者完全康复。
我们认为，在罕见的联合术后胸骨横断不愈合和肋骨切除后的胸壁缺损的情况下，这一点很重要。通过使用大小和形状合适的锁定板固定不愈合并用骨移植，并使用双层网膜覆盖胸壁缺损，我们的患者获得了良好的结果。
