Duke’s experienced surgeons offer the most up-to-date
methods to restore form and aid healing for patients with
congenital or acquired defects of the chest wall, including a
repair technique for patients with a sternum that does not heal
after open-heart surgery.
Reconstructive surgery can benefit many patients,
including:
- Patients with congenital contour deformities of the
chest, such as in Poland syndrome
- Patients with wound healing problems, usually resulting
from complications of surgery
- Cancer patients, who receive care from reconstructive
surgeons working as part of a multispecialty team to restore
form at the time of tumor resection
Reconstructive Flap Surgery
Duke is a leader in reconstructive flap surgery using
local flaps, regional flaps, and free tissue transfers.
With local and regional flaps, skin adjacent to the
affected area is used for reconstruction.
Patients with complex defects can benefit from free
tissue transfers, which improve appearance and provide
stable wound coverage. Duke is the largest center for
microsurgical free tissue transfers in the southeastern United
States.
Free tissue transfers involve completely removing living
tissue from other parts of the body to reconstruct the affected
area. Microsurgical techniques are then used to connect tiny
blood vessels to nourish the flap of skin.
Sternal Instability
For patients with a sternum (breast bone) that does not heal
after open-heart surgery, Duke offers an innovative repair
technique that reduces pain, improves quality of life, and aids
healing.
Duke offers the only program in the country treating this
rare condition, called sternal instability (also called sternal
nonunion).
Cardiothoracic surgery patients at high risk for sternal
instability include patients with:
- Morbid obesity
- Diabetes
- Chronic obstructive pulmonary disease
- Osteoporosis
- Transverse sternal fractures
Symptoms of sternal instability include persistent
sternal pain and clicking or grinding sensations. This
condition occurs when the wires normally used to close the
sternum after surgery pull through, or the sternum does not
completely heal.
Duke surgeons can treat sternal non-union using a device
developed at Duke. The device consists of surgical stainless
steel plates that pull the sides of the sternum together using
a ratchet mechanism.
The procedure stabilizes the sternum, which promotes healing
and relieves pain.
All patients treated with this technique have shown a marked
improvement in symptoms and have resumed recreational
activities they had been unable to pursue before repair.
The technique works well in patients with multiple bone
fragments. It can be combined with reconstruction plates if
necessary.
The procedure is performed under general anesthesia.
Hospital stays after the procedure range from one to 14 days;
the median stay is six days.
Patients with sternal instability will receive a
preoperative evaluation, including a cardiac workup to
rule out recurrent angina as a source of chest pain.
Spiral computed tomography (Spiral CT) scans are
taken of the chest to provide detailed information about
sternal anatomy. These scans also allow planning of the
approximate size of the plates needed.
Locations
This service is available at:
