Reconstruction Of Sternal Wounds With and Without Rigid Plate Fixation

Background: Management of sternal wound complications remains a significant challenge despite advancements over the last 50 years, notably the development of muscle flap coverage. Some have advocated for sternal plating in addition to flap coverage. While there is evidence that plating high-risk patients at the time of sternotomy can reduce the incidence of sternal complications¹, there is less data on the use of sternal plates after the development of a sternal complication^2,3. Despite this, plating is being used in secondary sternal reconstruction in an increasing fashion. We reviewed our experience with sternal reconstruction over the past 12 years, comparing the use of flaps alone versus the use of sternal plating and flap coverage.

Methods: 68 cases of sternal reconstruction from 1997-2011 met inclusion criteria. Plates with muscle flap coverage were used in 20 patients. Flaps alone were used in the other 48. Baseline characteristics and risk factors for wound complications were obtained, as well as indications for reconstruction and primary sternotomy. Outcome data included dehiscence, infection, reoperation, other wound complications, and length of hospital stay. 

Results: Comorbidities and reason for primary sternotomy were similar between groups, but indication for reconstruction differed considerably (p < 0.01): 60% of plated patients had sterile dehiscence, while 69% of non-plated patients were acutely infected. Mean time from sternotomy to reconstruction was 208 days for plates, vs 60 days for non-plated. 30% of plates had a post-op complication, vs 45.8% of non-plated (p = 0.3). Reoperation was necessary in 20% of plates vs 27.1% of non-plated (p = 0.6). No plated patients dehisced, vs 20.8% of non-plated (p = 0.03). 2 plated patients (10%) had their hardware removed. Four patients with acute infections were plated; none had complications.

Conclusions: At our institution, plates have been used selectively, mostly for sterile dehiscence and delayed reconstructions in medically stable patients. Acutely ill and infected patients were more often treated with traditional muscle flap reconstruction without plates. None of the plated patients dehisced after reconstruction, suggesting there is a role for plating, at least in medically stable patients at high risk for wound re-dehiscence. The small number of patients with acute infections who were plated fared well, but further study is needed to evaluate the use of plates in this setting.