title: Reconstruction of the chest wall with external metal brace: alternative technique in poststernotomy mediastinitis.
abstract: OBJECTIVE
  To demonstrate the experience with the reconstruction of the chest wall utilizing metal brace to reduce the tension in the suture lines of myocutaneous flap in cases of mediastinitis.
  
  
  METHODS
  From July 2001 to February 2006, 1389 heart surgeries were performed in our institution of which eight (0.6%) developed mediastinitis. Seven were male and the mean age was 56.7 years. The risk factors for infection were diabetes and obesity in seven and malnutrition in one case. Seven patients had been undergone CABG and one repair of a congenital heart disease. The chest wall reconstruction consisted of percutaneous insertion of Kirshner wires parallel to the edges of the wound for anchoring of sutures to the muscular plane in order to allow the reduction of tension in the free edges of the wound and subsequent closure of the subcutaneous tissue and skin.
  
  
  RESULTS
  There was one death in the immediate postoperative due to arrhythmia and one late death secondary to sepsis. The remaining patients presented satisfactory postoperative course with good healing of the wound after the removal of the metal braces on the 21st postoperative day and in the follow-up of 6 to 54 months.
  
  
  CONCLUSIONS
  The reconstruction of the chest wall utilizing temporary metal braces showed to be a safe and effective procedure with good aesthetic and functional outcomes in this group of patients.
authors.affiliation: Serviço de Cirurgia Cardíaca, Hospital Universitário, Universidade Federal do Maranhão. rvnina@terra.com.br
authors.forename: Vinicius José da Silva
authors.initials: VJ
authors.lastname: Nina
authors.forename: Marco Aurélio Salles
authors.initials: MA
authors.lastname: Assef
authors.forename: Raimundo Reis
authors.initials: RR
authors.lastname: Rodrigues
authors.forename: Vinícius Giuliano Gonçalves
authors.initials: VG
authors.lastname: Mendes
authors.forename: Joyce Santos
authors.initials: JS
authors.lastname: Lages
authors.forename: Angela Mirella Magalhães
authors.initials: AM
authors.lastname: Amorim
authors.forename: Natalino
authors.initials: N
authors.lastname: Salgado Filho
authors.forename: Rachel Vilela de Abreu Haickel
authors.initials: RV
authors.lastname: Nina
mesh_terms: D001864:Bone Wires; D001915:Braces; D006348:Cardiac Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000150:complications*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D013249:Sternum / Q000601:surgery; D013530:Surgical Wound Infection / Q000209:etiology; D013536:Suture Techniques; D035441:Thoracic Wall / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology