Reconstruction of Chronic Aseptic Sternal Pseudoarthrosis after Median Sternotomy: Initial Experience with the Ley Prosthesis
AbstractIt has previously been reported that the Ley prosthesis, a 0.5-mm-thick titanium alloy plate designed for reconstruction and stabilization of the unstable sternotomy, leads to shorter hospital stay and reduces the need for further surgical procedures in patients with postoperative mediastinitis after open heart surgery. We report our initial experience with the Ley prosthesis in patients with chronic aseptic sternotomy dehiscence. The study included 6 male patients (age 42-80 years) with opiate-derivate-dependent intractable pain and significantly reduced quality of life caused by noninfected sternal pseudoarthrosis and unstable sternotomy with large sternal bone tissue deficit. Four of the patients had undergone various surgical fixation procedures 8 days to 12 months after the primary operation. The patients were treated with reconstruction and stabilization of the sternum with the Ley prosthesis 10 to 40 months after the primary operation. In 1 patient bone transplantation was used. No immediate peri- or postoperative complications were observed, and all patients were discharged 4 to 11 days after surgery. One patient who received a bone transplant developed wound infection, and the prosthesis was removed 5 weeks after implantation. At 6-month follow-up all sternotomies were found stable, and patients reported that pain had decreased and quality of life was significantly improved. Our results demonstrate that the Ley prosthesis can be safely and efficiently used for the reconstruction and stabilization of the sternum in patients with intractable pain caused by noninfected postoperative sternal dehiscence and large sternal bone tissue deficit.
Astudillo R, Vaage J, Myhre U, Karevold A, Gardlund B. 2001. Fewer reoperations and shorter stay in the cardiac surgical ward when stabilising the sternum with the Ley prosthesis in postoperative mediastinitis. Eur J Cardiothorac Surg 20(1):133-9.nBertin KC, Rice RS, Doty DB, Jones KW. 2002. Repair of transverse sternal nonunions using metal plates and autogenous bone graft. Ann Thorac Surg 73(5):1661-2.nBitkover C, Gardlund B. 1998. Mediastinitis after cardiovascular operations: a case-control study of risk factors. 65:36-40.nCasha AR, Gauci M, Yang L, Saleh M, Kay PH, Cooper GJ. 2001. Fatigue testing median sternotomy closures. Eur J Cardiothorac Surg 19(3):249-53.nCohen DJ, Griffin LV. 2002. A biomechanical comparison of three sternotomy closure techniques. Ann Thorac Surg 73(2):563-8.nDalton ML, Connally SR. Median sternotomy. 1993. Surg Gynecol Obstet 176(6):615-24.nKouchoukos NT, Wareing TH, Murphy SF, Pelate C, Marshall WG Jr. 1990. Risk of bilateral internal mammary artery bypass grafting. Ann Thorac Surg 49(2):210-7.nMcGregor WE, Trumble DR, Magovern JA. 1999. Mechanical analysis of midline sternotomy wound closure. J Thorac Cardiovasc Surg 117(6):1144-50.nMears DC, Velyvis J. Surgical reconstruction of late pelvic post-traumatic nonunion and malalignment. 2003. J Bone Joint Surg Br 85(1):21-30.nPai S, Gunja NJ, Dupak EL, et al. 2005. In vitro comparison of wire and plate fixation for midline sternotomies. Ann Thorac Surg 80(3):962-8.nRobicsek F, Daugherty HK, Cook JW. 1977. The prevention and treatment of sternum separation following open-heart surgery. J Thorac Surg 73:267-8.nSzerafin T, Osama J, Gyory F, Petterfy A. 2001. Surgical treatment of sternal dehiscence after sternotomy using Ley prosthesis. Magy Seb 54(6):375-8.nTarelli G, Maugeri R, Pedretti R, Grossi C, Ornaghi D, Sala A. 1998. The use of bilateral mammary artery in myocardial revascularization: the risk factors emergent from a multivariate analysis conducted on 474 patients. G Ital Cardiol 28(11):1230-7.n
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).