Anne Olland, Jérémie Reeb, Sophie Guinard, Joseph Seitlinger, Stéphane Renaud, Nicola Santelmo, Romain Kessler, Pierre-Emmanuel Falcoz, Gilbert Massard
Institutions : Groupe de transplantation pulmonaire, hôpitaux universitaires de Strasbourg ; EA7293 Stress vasculaire et tissulaire en transplantation, Fédération de médecine translationnelle, faculté de médecine de Strasbourg
Objectives : Clamshell incision is an invasive procedure that keeps an indication especially in lung transplantation. Nevertheless, post-operative sternal cicatrization may complicate to sternal instability with overriding, sternal instability, pain, and impair respiratory rehabilitation. We aimed at testing efficacy of adsorbable poly-L lactic acid pins to maintain sternal alignement until complete sternal healing.
Methods : We recorded all bilateral lung transplantations requiring clamshell procedure and using adsorbable sternal pins for bone reinforcement. The sternum was closed with three PDS cross sutures: one sternal suture, and one suture on each side of the sternum with respect to the technique that evidenced lowest complication rate in international literature. We recorded patient’s caracteristics and sternal post-operative complications.
Results : Starting January 1st 2016, we performed 40 lung transplants including 37 bilateral lung transplants; fourteen required clamshell incision either for cariopulmonary bypass (n=8), or for better surgical exposure (n=6). Eleven transversal sternotomies were closed using sternal pins in order to limit antero-posterior movements. For 3 patients we could not use this technique. None of the patients with sternal pins closure demonstrated postoperative sternal complications. Two patients among the three without sternal pins presented with complete sternal overriding, chest instability and impairing pulmonary rehabilitation. Both patients underwent reoperation for sternal closure placing sternal pins as a second intention
Conclusion : Using adsorbable sternal pins ensures sternal stability until complete bone healing though immunosuppressive therapy without impairing pulmonary rehabilitation. Sternal pins may also be used as second intention when repairing sternal overriding.