DISCUSSION
Sternal dehiscence and infection problems of bone structure are complications after cardiac surgery and thoracic surgery, and incidence rate is between 0.5% and 5%. [7] In many cases where sternum revision is required, a simple wire circling, which is the most common method for sternal wound treatment, may not be sufficient to provide sternal stability, especially when a significant part of the sternum is resected. [8,9] In these cases, simple wire circling may cause sternum injury. Because tension may be applied to these areas even using the Robicsek technique. Unstable sternal fixation may cause non-healing of wound. Considering orthopedic principles, limiting movement between broken bone parts is extremely important for bone healing. [10] Supporting thoracic wall with metal plates may provide stabilization and immobilization of thoracic wall, and therefore it have been reported that promising for the treatment of a complicated sternum after major cardiac surgery. [11]
Conventional methods have failed to solve the chest wound problem. Most parts of sternum must be healthy to close sternum using traditional methods (simple wiring or Robicsek technique). Various disadvantages have been reported that such as use of titanium plates is more expensive than conventional methods to close sternum and dislocation of screws. [12] Although these disadvantages, we consider that using titanium plates and supporting plates with prolene patches are very effective to provide sternal stability even wide resection of sternum, as in our case.
In addition to using titanium plates in the treatment of sternal dehiscence and osteomyelitis, a muscle flap may be required to provide thoracic wall stability in large defects. Pectoralis major muscle flap, omental flaps, rectus abdominis flaps and latissimus dorsi flaps may be used in reconstruction of sternum defects. [13] Prolene patch, titanium plate and pectoral flaps were used to treat in large defect of our patient. We consider that this flap is effective to provide the stability of the thoracic wall and to control the infection of tissues. In the literature, it was reported that using the flap is successful in the treatment of sternal dehiscence and osteomyelitis. [14]