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Successful Method in the Treatment of Complicated Sternal Dehiscence and Mediastinitis Cases: Strasbourg Thoracic Osteosyntheses System (STRATOS)
Erdal Yekeler, Furkan M. Sahin, Alkin Yazicioglu, Ali Muhammed Beyoglu
Ankara City Hospital, University of Health Sciences, Ankara, Turkey, Ankara, Turkey

OBJECTIVE: Sternal dehiscence and mediastinitis due to median sternotomy following open-heart surgery is a serious complication that is difficult to manage. In our study, we evaluated the results of the method we used to treat this complication occurring after cardiovascular surgery.
METHODS: Sternal reconstruction with a new method named “Strasbourg Thoracic Osteosyntheses System” (STRATOS) was applied to 13 patients who developed sternal dehiscence and mediastinitis after cardiac surgery between July 2014 and March 2019. Datas were analyzed retrospectively.
RESULTS: The mean age of our cases was 60,3 ± 2,9 (33-74). The most frequently accompanying risk factor was DM (n = 7, 53.8%). Before the procedure, reconstruction was performed by using the robiscek technique in three cases and a conventional rewiring technique was used in one case. All of the cases had sternal purulent discharge (n = 12, 92%). Except for four cases, all cases had at least two fracture lines in the sternum (n = 9, 69%). 1-10 sessions of (median = 4) "Vacuum-Assisted Closure" (VAC) therapy was used in cases before the procedure. Except for three cases, all of the cases were placed transdiafragmatic harvested omentum in the sternal cavity. Incisional hernia developed in one of the cases. Thorax stabilization was successfully achieved in all cases.
CONCLUSIONS: Thorax stabilization can be successfully achieved in complicated sternal dehiscence cases with the STRATOS technique supported by VAC therapy until the culture turns negative in the preoperative period and by the use of transdiaphragmatic omentum intraoperatively inside the sternal cavity.


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