Sternum/Chest Wall Reconstruction

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:

• Duke Wound Management Clinic
  Duke Clinic 3J, 200 Trent Drive, Durham, NC 27710