J Thorac Cardiovasc Surg 1994;108:1160-1161
© 1994 Mosby, Inc.
Stabilization of the chest with absorbable cord after sternal resection
Hans W. Keller, MD,
Heinz Pichlmaier, MD
Department of Surgery
University Hospital of Köln
Joseph-Stelzmann-Strasse 9
5 Köln 41, Germany
To the Editor:
Extended sternal resections require stabilization of the chest to provide ordinary ventilation
1 Steel struts 2and autologous ribs 3 or plastic prosthetic material 1 and even transitory external stabilization 4 are recommended to reinforce the reconstruction (mesh coverage) of the anterior chest wall. Costal transplantation necessitates extended rib resection and may not be useful in patients with poor bone quality. Metal implants disturb nuclear magnetic resonance and computed tomographic scans during follow-up investigations. For these reasons we recently have preferred absorbable cords for stabilization of the thorax until the cicatrization gives enough strength to the anterior chest wall.
After sternal resection a plastic sheet (Marlex mesh, Bard Implants, Billerica, Mass.) is infolded under tension to cover the defect primarily. Further stabilization is achieved by banding the ends of the ribs on either side of the chest wall with a 1.5 mm absorbable polydioxanone cord (Figs. 1 and 2). Finally, a flap of the greater omentum is prepared to fill up the space between the sheet and the skin, covering the cords.
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Fig. 2. Reconstruction of the anterior chest wall after resection of the sternal body with Marlex mesh and polydioxanone banding of the ribs.
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Absorbable cords are popular among orthopedic surgeons as alternatives to metallic implants (e.g., treatment of acromioclavicular dislocations or dehiscence of the pubic symphysis). The cord gives enough strength to reinforce syndesmorrhaphy and allows an elastic osteosynthesis. It avoids the problems of metallic implants such as breaking, dislocation, and loosening, as well as the necessity of another operation to remove the implanted material. Chest wall stabilization with the cords provides the same advantages.
The breaking strength of the polydioxanone depends on the suture size. More than 50% is retained at 4 weeks. 5 The material is completely absorbed by simple hydrolysis after 6 months. 5
The procedure described is especially useful in case of resection of the entire sternal body. Because the cord banding enables normal breathing immediately after the operation, ventilation by tracheotomy is not necessary. In case of total sternal resection including the whole manubrium, additional stabilization of the clavicles, however, is necessary, which can easily be achieved with autologous bone transplantation using iliac crest material.
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