Radical sternectomy could be less risky than conservative

Researchers say that radical sternectomy encompassing the costal cartilages leads to a significantly lower rate of complications and reoperation than conservative sternectomy.

However, Eric Chang (University of California, Los Angeles, USA) and team found that radical sternectomy did not lead to significantly lower rates of mortality.

They retrospectively reviewed the chest wall reconstructions of 54 patients who underwent the procedure between January 2000 and December 2010. Of these patients, 24 underwent conservative sternal debridement with flap closure (defined as debridement of only bony sternum but no costal cartilage resection), 24 underwent radical sternectomy including resection of the costal cartilages followed by flap closure, and six underwent radical sternectomy with vacuum-assisted closure (VAC) therapy followed by flap closure in a delayed fashion.

The results showed that 15 patients in the conservative sternectomy group experienced postoperative complications (superficial wound dehiscence or cellulitis, reoperation due to serious complications such as flap dehiscence, or hematoma formation) compared with eight patients in the radical sternectomy group (62.5 vs 33.3%).

The conservative sternectomy group also experienced significantly more serious complications requiring reoperation than the radical sternectomy group, at 86.7% versus 25.0%. The most common of these complications in the conservative group was flap dehiscence, which occurred in 53.3% of patients, while superficial wound infection was the most common in the radical group, occurring in 75.0% of patients.

There were no complications in patients undergoing radical sternectomy with VAC placement.

Of note, there was no significant difference in mortality or length of hospital stay between the conservative and radical sternectomy groups.

"Although the management of this potentially fatal problem has evolved significantly in the past decade, uncertainty remains regarding definitive treatment protocols," remark Chang and team in Annals of Plastic Surgery. "In this study, radical sternectomy encompassing the costal cartilages results in a lower rate of complications and reoperation compared to conservative sternectomy."

They conclude: "Interim VAC therapy may offer another valuable tool for chest wall reconstruction that portends even better results than radical sternectomy with immediate flap closure."

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