Thoracic Surgery and Lung Transplantation Department, Reina Sofía University Hospital, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Spain.
Thoracic Surgery and Lung Transplantation Department, Reina Sofía University Hospital, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Spain.
Transplant Proc. 2023 Dec;55(10):2307-2308. doi: 10.1016/j.transproceed.2023.08.031. Epub 2023 Oct 4.
We report a case of a complex chest wall reconstruction because of sternal dehiscence, requiring different surgical procedures for its complete resolution.
A 54-year-old man patient with Langerhans cell histiocytosis and chronic obstructive pulmonary disease underwent bilateral sequential lung transplantation through a clamshell incision, using nitinol thermo-reactive clips for sternal closure. One year later, he consulted because of chest pain, fever, and purulent secretions. Physical examination and chest X-ray revealed a right pulmonary hernia due to post-clamshell wound dehiscence. Chest wall repair was performed, placing an expanded-polytetrafluoroethylene synthetic mesh, and the sternum was realigned and fixated with titanium plates and screws. However, in the immediate postoperative period, there was a large amount of serous drainage through the surgical wound, needing negative pressure therapy. Unfortunately, the wound became necrotic with exposure to the osteosynthesis material. In addition, a chest computed tomography scan showed fluid accumulation in the anterior chest wall. Therefore, two-stage revision surgery was indicated: first, the removal of the previous prosthesis and, the definite one, the use of a pedicled latissimus dorsi myocutaneous flap to provide effective coverage of the wound.
Sternal dehiscence is not an uncommon complication after clamshell incision in patients undergoing bilateral sequential lung transplantation, and it is associated with significant morbidity. In the presence of chest wall instability, surgical repair is mandatory.
我们报告了一例复杂的胸壁重建病例，该患者因胸骨裂开需要进行不同的手术程序来完全解决该问题。
一名 54 岁男性患者患有朗格汉斯细胞组织细胞增生症和慢性阻塞性肺疾病，通过蛤壳切口进行了双侧序贯肺移植，使用镍钛诺热反应夹进行胸骨闭合。一年后，他因胸痛、发热和脓性分泌物就诊。体格检查和胸部 X 射线显示由于蛤壳切口后伤口裂开导致右侧肺疝。进行了胸壁修复，放置了膨体聚四氟乙烯合成网，并通过钛板和螺钉重新排列和固定胸骨。然而，在术后即刻，大量浆液性引流物通过手术伤口排出，需要负压治疗。不幸的是，伤口发生了坏死，露出了内固定材料。此外，胸部计算机断层扫描显示前胸壁有积液。因此，需要进行两阶段修正手术：首先，移除先前的假体，然后使用带蒂背阔肌肌皮瓣提供有效的伤口覆盖。
在双侧序贯肺移植患者中，蛤壳切口后胸骨裂开并不少见，且与显著的发病率相关。在存在胸壁不稳定的情况下，必须进行手术修复。
