Étiquette : Wound closure

Vol. 20 JA2016 - thoracic

T-04 – Advantages of adsorbable pins for closure of transversal sternal sections
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.
novembre 29, 2016
Vol. 20 JA2016 - thoracic

T-06 – Results of the first implantations of Ceramil® prosthesis, a new device for sternal replacement
Jérémy Tricard, Alessandro Piccardo, Nicolas Pichon, Denis Asselineau, François Bertin Institution : Service de chirurgie thoracique et cardiovasculaire et angiologie, CHU Dupuytren, Limoges Objectives : Many materials have been proposed to be used in reconstructive surgery of the chest wall but none has emerged as an ideal substitute. The Ceramil® prosthesis is an innovating material for replacement of the sternum. We present the device, the implantation technique and the follow-up of the first 4 recipients. Methods : The Ceramil® prosthesis is a porous alumina ceramic which is a pure compound of mineral origin that presents osteointegration and biocompatibility properties. Its size is adapted to the sternal defect and chosen before the surgery among different made-to-measure models. Its implantation does not require osteosynthesis equipment. From March 2015 to March 2016, 4 patients underwent surgery for sternal replacement and received the Ceramil® prothesis. A 54-year old patient (n°1) had a radiation-induced sarcoma after a radiotherapy for breast cancer, a 61-year old patient (n°2) had a sternal necrosis due to a mediastinitis after sternotomy, 2 patients of 53 and 37 years old (n°3 and 4) had sternal metastasis from breast neoplasia. Results : Patient n°1 was reoperated on D7 for a seroma. After an 19-month follow-up, she was not dyspneic (grade 1 of the CEE scale) and had no sternal pain or scarring disorder. Patient n°2 was reoperated after 3 months for wound care and closure as he presented with tissue necrosis due to a history of chest radiotherapy. After a 14-month follow-up, he presented with grade 2 dyspnea, sternal pain graded as 3 on the visual analog scale (VAS) and the operation wound was healed. After an 11-month follow-up, patient n°3 was not dyspneic and had no sternal pain or scarring disorder. After a 7-month follow-up, patient n°4 presented with grade 2 dyspnea, sternal pain graded as 3 on the VAS and no scarring disorder. Conclusion : The Ceramil® prosthesis implanted as a replacement for the sternum appears to be reliable, reproducible and promising. A monocentric study (STOIC) and a multi-center study (ISBA) are currently performed.
novembre 29, 2016
Vol. 20 JA2016 - thoracic

T-11 – VAC Therapy with delayed chest wall closure: a rescue solution in case of intraoperative DIC
Geoffrey Brioude, Brice Caput, Joséphine Chenesseau, Delphine Trousse, Xavier-Benoît D’Journo, Christophe Doddoli, Pascal-Alexandre Thomas Institution : Service de chirurgie thoracique et des maladies de l’œsophage, hôpital Nord, AP-HM, Marseille Objectives : VAC therapy is actually used routinely in infected thoracic wound. We reported in this presentation an original use in thoracic surgery: VAC therapy to maintain sterile an unclose chest wall in lung transplant after massive bleeding managed with damage control surgery or after brutal lung oedema. Methods : Lung transplant is an uncommun part in thoracic surgery, performed in specialized center. Surgeons are confronted to major bleeding due to patient’ background and the frequent use of ECMO in per-operating and post-operative. Furthermore lung tranplants are exposed to a major oedema included in the primary graft dysfunction. We decided to report an originally case series of management of catastrophic bleeding and lung oedema in lung transplantation. Results : Between January 2014 and august 2016, 100 bilateral lung transplant were performed in our unit. 19 patients were re-operated. Fourteen of them for postoperative hemothorax or bleeding, 4 for anastomotic leakage and 1 for a delayed chest wall closure. We identified 7 patients requiring a pleural packing or VAC therapy following surgery. Four of them had pleural packing for bleeding at the end of lung transplant more or less associated to VAC therapy. Two patients had a delayed strategy (day 2 or 3) for pleural packing. One patient had only a VAC therapy due to a major lung oedema. Five patients were weaned of the circulatory support and had a chest was closure in a period between day 5 and day 15. Two patients died of an uncontrolled bleeding. A mean of 3.4 intervention were realized onbed in ICU or in the OR. Conclusion : Pleural packing and delayed chest wall closure used in a spirit of damage control surgery is an efficient option in case of uncontrolled bleeding associed with lung oedema after lung transplantation
novembre 29, 2016