Sternal resection and reconstruction.
Twenty-one patients underwent sternal resection and reconstruction. Surgical indications included sternal infection in 9 patients, recurrent breast cancer in 6, metastatic carcinoma from an unknown primary in 2, pectus excavatum in 2, and osteogenic sarcoma and eosinophilic granuloma in 1 each. Management included partial sternectomy in 10 patients (group 1) and complete sternectomy in 11 (group 2). Chest wall reconstruction was by various flaps and mesh repairs. Blood transfusions averaged 2 units in group 1 versus 5.5 units in group 2 (p = 0.02). Average number of days until extubation was 2.6 in group 1 versus 7.3 in group 2 (p = 0.04). Average number of intensive care unit days was 4.4 for group 1 versus 9.4 for group 2 (p = 0.03). The number of days until discharge was 14 days for group 1 versus 20 days for group 2. Complications occurred in 40% of group 1 and 82% of group 2 patients. Overall mortality was 9.5%. Sternal resection and reconstruction, particularly complete sternal resections, are a major undertaking with substantial morbidity. Using a multidisciplinary approach (cardiothoracic, plastic and reconstructive, critical care medicine, and infectious disease) and aggressive pulmonary support, acceptable cosmetic and functional results are possible.
Mansour
K A
KA
Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
Anderson
T M
TM
Hester
T R
TR
D000293:Adolescent; D000328:Adult; D000368:Aged; D001847:Bone Diseases / Q000601:surgery; D001859:Bone Neoplasms / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000601:surgery; D006801:Humans; D007239:Infections / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019736:Prostheses and Implants; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D013524:Surgical Flaps / Q000379:methods