DISCUSSION
Sternal dehiscence and infection problems of bone structure are
complications after cardiac surgery and thoracic surgery, and incidence
rate is between 0.5% and 5%. [7] In many cases where sternum
revision is required, a simple wire circling, which is the most common
method for sternal wound treatment, may not be sufficient to provide
sternal stability, especially when a significant part of the sternum is
resected. [8,9] In these cases, simple wire circling may cause
sternum injury. Because tension may be applied to these areas even using
the Robicsek technique. Unstable sternal fixation may cause non-healing
of wound. Considering orthopedic principles, limiting movement between
broken bone parts is extremely important for bone healing. [10]
Supporting thoracic wall with metal plates may provide stabilization and
immobilization of thoracic wall, and therefore it have been reported
that promising for the treatment of a complicated sternum after major
cardiac surgery. [11]
Conventional methods have failed to solve the chest wound problem. Most
parts of sternum must be healthy to close sternum using traditional
methods (simple wiring or Robicsek technique). Various disadvantages
have been reported that such as use of titanium plates is more expensive
than conventional methods to close sternum and dislocation of screws.
[12] Although these disadvantages, we consider that using titanium
plates and supporting plates with prolene patches are very effective to
provide sternal stability even wide resection of sternum, as in our
case.
In addition to using titanium plates in the treatment of sternal
dehiscence and osteomyelitis, a muscle flap may be required to provide
thoracic wall stability in large defects. Pectoralis major muscle flap,
omental flaps, rectus abdominis flaps and latissimus dorsi flaps may be
used in reconstruction of sternum defects. [13] Prolene patch,
titanium plate and pectoral flaps were used to treat in large defect of
our patient. We consider that this flap is effective to provide the
stability of the thoracic wall and to control the infection of tissues.
In the literature, it was reported that using the flap is successful in
the treatment of sternal dehiscence and osteomyelitis. [14]