A paradigm shift for sternal reconstruction using a novel titanium rib bridge system following oncological resections

Abstract

Objectives: The postoperative course following sternectomy for cancer carries significant morbidity due to paradoxical breathing, pulmonary infections and infectious complications. The purpose of this report is to evaluate the outcomes in patients undergoing sternal reconstruction using an innovative titanium rib bridge system (STRATOS).

Methods: From 2008 to 2011, 24 patients underwent sternectomy with a titanium rib bridge system reconstruction. Soft coverage tissue was performed concurrently using a prosthetic mesh and pedicled or free flaps. Postoperative data were collected prospectively.

Results: The median age was 56 (31-85 years). The indications for sternal resection were primary sarcoma (n = 4), metastasis (n = 15) and radiation-induced sarcoma (n = 5). Twenty-one subtotal and three total sternectomies were performed. Resection margins included the anterior rib (n = 13, mean: 2/patient), clavicles (n = 9), breast (n = 4), superior vena cava (n = 1), pericardium (n = 5), phrenic nerve (n = 4), lung (n = 6) and diaphragm (n = 1). The stability of the chest wall typically required an average of two titanium bars and rib clips per patient. There was no perioperative mortality. Twenty-three patients were extubated within the first 24 h. The mean intensive care unit and hospital stay was 3.5 and 14 days, respectively. Wound infection did occur in one patient but did not require the removal of the titanium rib system. The postoperative forced expiratory volume in 1 s did not differ significantly from the preoperative status (P = 0.07).

Conclusions: After sternectomy for cancer, reconstruction with a titanium rib bridge system has low morbidity and permits a rapid return to baseline pulmonary mechanics.