Reconstruction of the chest wall with external metal brace: alternative technique in poststernotomy mediastinitis.
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.
Nina
Vinicius José da Silva
VJ
Serviço de Cirurgia Cardíaca, Hospital Universitário, Universidade Federal do Maranhão. rvnina@terra.com.br
Assef
Marco Aurélio Salles
MA
Rodrigues
Raimundo Reis
RR
Mendes
Vinícius Giuliano Gonçalves
VG
Lages
Joyce Santos
JS
Amorim
Angela Mirella Magalhães
AM
Salgado Filho
Natalino
N
Nina
Rachel Vilela de Abreu Haickel
RV
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