Repair of chronic noninfectious sternal dehiscence using sternal clips and an autologous costal cartilage graft: a case report
DOI:
https://doi.org/10.24054/cbs.v4i4.4667Keywords:
Sternal dehiscence, sternotomy, nonunion, internal fixation, costal cartilageAbstract
Introduction: Post-sternotomy sternal dehiscence ranges from aseptic mechanical failure to deep surgical-site infection and mediastinitis. Differentiating these entities determines the therapeutic strategy. We report delayed repair of noninfectious sternal dehiscence after resection of an intrathoracic goiter using rigid sternal clips and an autologous costal cartilage graft. Case presentation: A 47-year-old woman with obesity underwent for an intrathoracic goiter through a median sternotomy at another institution. She developed postoperative hypocalcemia, followed by sternal clicking, pathological mobility, and progressive pain that became disabling during the six months preceding evaluation. She never developed fever, drainage, progressive erythema, or other clinical signs of infection. Chest computed tomography with three-dimensional reconstruction showed complete separation of the middle third of the sternal body and failure of the cerclage wires. Eighteen months after the index operation, surgical re-exploration, removal of the previous material, preparation of the sternal bed, fixation with MedXpert sternal clips, and interposition of an autologous costal cartilage graft were performed. A closed soft-tissue drain was placed. Outcome: The postoperative course was favorable, without fever or respiratory distress, with satisfactory pain control, clinical sternal stability, and adequate implant position on postoperative radiography. The patient was discharged on postoperative day two. At the first outpatient visit, the wounds were healthy, drainage was minimal and serous, and the sternum remained stable. Conclusion: Rigid clip fixation combined with an autologous graft may be a reasonable reconstructive option for delayed noninfectious sternal dehiscence with an interfragmentary defect and functional limitation, provided infection is excluded and the technique is individualized.
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