HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Google Scholar Articles by Al-Ebrahim, K. E. PubMed Articles by Al-Ebrahim, K. E. Related Collections Chest wall

Letters to the Editor

Use of titanium plates in repair of adult complete sternal cleft

Department of Cardiothoracic Surgery, King AbdulAziz University Hospital, P O Box 80215, Jeddah 21589, Saudi Arabia

Received 7 March 2009; accepted 16 March 2009.

^_* Corresponding author. Tel.: +966 6401000; fax: +966 6401238. (Email: dr.k-e{at}hotmail.com).

Key Words: Sternal cleft • Titanium plates

I read with interest the recent article (Twenty seven-year experience with sternal cleft repair) by de Campos and associates [1] describing their sternal reconstruction techniques in 15 patients and follow-up for 27 years. Recently, I used titanium plates for direct primary closure of a complete sternal cleft in a 35-year-old female. My initial operative plan was for sternal reconstructive technique, but trying intraoperative approximation of both sternal edges which was well tolerated, encouraged me to perform direct closure. I agree with the authors that the best time for repair is in infancy where direct closure is much easier as the chest wall is elastic and flexible. The sternal fixation system using plates is ideal for those patients as there is not enough sternal bone to use stainless steel wires. This system has been used in patients with mediastinitis and complicated sternal dehiscence instead of the conventional closure and has proved to be effective [2]. The other advantage of this system is its locking and unlocking feature which allow easy opening in re-exploration. The width of the cleft is the most important factor determining the possibility of direct closure. In our case it was about 6 cm in inspiration which is considered a fairly wide space and we think that the gradual closure plus opening the left pleural cavity helped in avoiding cardiac compression. The main drawbacks and hazards of complex sternal reconstruction is the huge amount of foreign body material with its liability to untoward reaction, infection, extra weight on the sternum and the difficulty of going back to the heart or other mediastinal structures in the future for any surgical procedure. I think simple sternal closure should be attempted in those patients before embarking on a complex reconstruction with all its drawbacks.

References

1. de Campos J-RM, Periera JCDN, Velhote MCP, Jatene FB. Twenty seven-year experience with sternal cleft repair. Eur J Cardiothorac Surg 2009;35:539-541.[Abstract/Free Full Text]
2. Voss B, Bauenrschmitt R, Will A, Krane M, Kross R, Brockmann G, Libera P, Lange R. Eur J Cardiothorac Surg 2008;34:139-145.[Abstract/Free Full Text]

This article has been cited by other articles:

				J.-R. M. de-Campos and J.-C. Das-Neves-Pereira Reply to Al-Ebrahim Eur. J. Cardiothorac. Surg., July 1, 2009; 36(1): 227 - 227. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Google Scholar Articles by Al-Ebrahim, K. E. PubMed Articles by Al-Ebrahim, K. E. Related Collections Chest wall