Cardiothoracic Surgery |

Interclavicular Stabilization With the Synthes Sternal Fixation System After Radical Manubriectomy: Report of 3 Cases FREE TO VIEW

Eric Toloza, MD; Kathryn Rodriguez, BS; Christian Sobky, BS; Lori Brown, MD; Joseph Garrett, ARNP-C; Christy Chai, MD; Carla Moodie, PA-C; Rajendra Bhati, MD; Gerard Mosiello, MD; Jonathan Zager, MD
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Moffitt Cancer Center, Tampa, FL

Chest. 2014;145(3_MeetingAbstracts):35A. doi:10.1378/chest.1836701
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SESSION TITLE: Surgery Case Report Posters II

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Radical manubriectomy for manubrial tumors often destabilizes one or both upper extremities, but current reconstructive techniques prevent lateral but not medial clavicular displacement.

CASE PRESENTATION: Patient #1 is a 44-year-old man with manubrial plasmacytoma. Patient #2 is a 41-year-old man with upper chest basal cell carcinoma involving the manubrium. Patient #3 is a 64-year-old woman who is 14 months status post radical manubriectomy for metastatic thyroid cancer and whose clavicles were initially stabilized with daisy-chained loops of sternal wires, which broke while closing a car door. The three patients had mean age 49.7+7.2 yr, mean BSA 2.2+0.18 m2, mean BMI 39.3+5.8 kg/m2, and mean smoking history 15.0+7.6 pk-yr. After radical manubriectomy in the 1st two patients and removal of the broken sternal wires in the 3rd patient, each patient underwent interclavicular stabilization using angled titanium plates from the Synthes Sternal Fixation System. Pt#2 also had bilateral pectoralis muscle flaps. Mean operative (skin-to-skin) time was 153+23.3 min; mean intraoperative estimated blood loss was 273+153 mL. Patient #2 was returned to OR on postoperative day (POD)#3 for right chest hematoma, and Patient #3 was returned to OR on POD#4 for left clavicular titanium sternal plate refixation. Additional perioperative complications occurred in Patient #2 (hypoxia from pneumonia) and in Patient #3 (hemorrhoids from loose stools). Mean hospital length of stay was 5.7+1.3 days. Follow-up of the 3 patients at 3 years, 3 months, and 2 years, respectively, (mean 668+292 days) revealed no sternal plate dehiscence, despite Patient #1’s routinely unloading and reloading his airboat onto its trailer and his learning to SCUBA.

DISCUSSION: Interclavicular stabilization with angled titanium sternal plates prevent lateral or medial displacement of the shoulders for optimum position of the upper extremities to maximize range of motion and function. The Synthes sternal titanium plate also has a midline release pin in case of need for emergent sternal entry.

CONCLUSIONS: Interclavicular titanium sternal plates effectively prevent both lateral and medial clavicular displacement after radical manubriectomy.

Reference #1: None.

DISCLOSURE: The following authors have nothing to disclose: Eric Toloza, Kathryn Rodriguez, Christian Sobky, Lori Brown, Joseph Garrett, Christy Chai, Carla Moodie, Rajendra Bhati, Gerard Mosiello, Jonathan Zager

Use of Synthes Sternal Fixation System is not yet approved for interclavicular stabilization.




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