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Sternal reconstruction by extracellular matrix: a rare case of phaces syndrome.

ABSTRACT: Congenital defects of the sternum are rare and due to a failure of midline development and fusion of the sternal bones. Surgical correction of a sternal cleft should be preferred during infancy for functional reasons. Chest wall reconstruction represented a complex problem in the last decades. We report our successful outcome of sternal reconstruction in a rare case of PHACES syndrome, in which the patient was submitted to reconstruction of the sternum and complete closure of the thoracic defect by the employ of an extracellular matrix XCM Biologic tissue matrix. We promote the use of extracellular matrix in surgical reconstruction of chest defects for its maneuverability, plasticity, tolerability and the possibility of growing with the children's chest getting a good compliance and optimal cosmetic results.

SUBMITTER: Molinaro F

PROVIDER: S-EPMC5329824 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Sternal reconstruction by extracellular matrix: a rare case of phaces syndrome.

Molinaro Francesco F Garzi Alfredo A Cerchia Elisa E Di Crescenzo Vincenzo Giuseppe VG Luzzi Luca L Bulotta Anna Lavinia AL Gotti Giuseppe G Messina Mario M

Open medicine (Warsaw, Poland) 20160623 1

Congenital defects of the sternum are rare and due to a failure of midline development and fusion of the sternal bones. Surgical correction of a sternal cleft should be preferred during infancy for functional reasons. Chest wall reconstruction represented a complex problem in the last decades. We report our successful outcome of sternal reconstruction in a rare case of PHACES syndrome, in which the patient was submitted to reconstruction of the sternum and complete closure of the thoracic defect ...[more]

PMID: 28352793

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Project description:BACKGROUND:Sternal fractures are rare accounting for about 3-8% of traumatic chest. There are many lines of treatments for sternal fractures which can be classified as conservative or surgical. Surgical techniques include wire fixation and sternal plating. There are no standardization of indications for each line of management. We explore if sternal reconstruction using locking titanium plates and self-tapping screws provide the patient with the best chance of proper sternal healing avoiding chronic pain and its complications and allow the patient early mobilization and rapid restoring of his normal life at its maximum. METHODS:Our inclusion criteria are patients of both gender from 20 to 60?years of age presented with traumatic sternal fracture at any site or pathological fracture due to metastatic or primary tumors infiltrating the sternum. High Associated Injury Scale scores were excluded. Exclusion criteria also included patients younger than 20?years or older than 60?years. Primary outcome is post-operative pain score and is measured using numerical pain scale ranging from zero to 10 where zero means there is no pain at all and ten is the worst imaginable pain ever. RESULTS:Sternal reconstruction using titanium plates has proven to be an efficient method of stabilization with tremendous immediate relief of pain showed by the differences between pre-operative and post-operative pain scale scores in our patients (n?=?5) with Median scores being 7 and 1.5 with range being from 7 to 9 and 1 to 3 respectively (p-value?=?.039). Operative time range between 150?min and 90?min with median of 120?min. Extubation of patients was smooth with no events with median time of extubation being 120?min. From our experience, there were no observed wound complications except at the third patient who suffered a small wound hematoma that was resolved by gentle compressing only and needed no further intervention. CONCLUSION:We recommend adopting sternal reconstruction using titanium plating systems more readily encouraging even larger clinical trials on the way to a clear guidelines. Plating systems show promising results with least pain, better stability, less complications and rapid, smooth recovery. TRIAL REGISTRATION:NCT04092374.

Dataset Information

Sternal reconstruction by extracellular matrix: a rare case of phaces syndrome.

Publications

Sternal reconstruction by extracellular matrix: a rare case of phaces syndrome.

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