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Interactive Cardiovascular and Thoracic... Jun 2012Pectus excavatum and pectus carinatum represent the most frequent chest wall deformations. However, the pathogenesis is still poorly understood and research results... (Review)
Review
Pectus excavatum and pectus carinatum represent the most frequent chest wall deformations. However, the pathogenesis is still poorly understood and research results remain inconsistent. To focus on the recent state of knowledge, we summarize and critically discuss the pathological concepts based on the history of these entities, beginning with the first description in the sixteenth century. Based on the early clinical descriptions, we review and discuss the different pathogenetic hypotheses. To open new perspectives for the potential pathomechanisms, the embryonic and foetal development of the ribs and the sternum is highlighted following the understanding that the origin of these deformities is given by the disruption in the maturation of the parasternal region. In the second, different therapeutical techniques are highlighted and based on the pathogenetic hypotheses and the embryological knowledge potential new biomaterial-based perspectives with interesting insights for tissue engineering-based treatment options are presented.
Topics: Funnel Chest; History, 16th Century; History, 19th Century; History, 20th Century; Humans; Incidence; Risk Factors; Sternum; Thoracic Surgical Procedures; Treatment Outcome
PubMed: 22394989
DOI: 10.1093/icvts/ivs045 -
Proceedings of the Royal Society of... Mar 1970
Topics: Adult; Chronic Disease; Humans; Male; Melioidosis; Penicillins; Sternum; Sulfamethoxazole
PubMed: 5445578
DOI: No ID Found -
Ugeskrift For Laeger Feb 2024
Topics: Humans; Escherichia coli; Sternum
PubMed: 38445331
DOI: 10.61409/V72012 -
Scientific Reports Aug 2022The sternum is a stabilizing element in the axial skeleton of most tetrapods, closely linked with the function of the pectoral girdle of the appendicular skeleton.... (Review)
Review
The sternum is a stabilizing element in the axial skeleton of most tetrapods, closely linked with the function of the pectoral girdle of the appendicular skeleton. Modern mammals have a distinctive sternum characterized by multiple ossified segments, the origins of which are poorly understood. Although the evolution of the pectoral girdle has been extensively studied in early members of the mammalian total group (Synapsida), only limited data exist for the sternum. Ancestrally, synapsids exhibit a single sternal element and previously the earliest report of a segmental sternum in non-mammalian synapsids was in the Middle Triassic cynodont Diademodon tetragonus. Here, we describe the well-preserved sternum of a gorgonopsian, a group of sabre-toothed synapsids from the Permian. It represents an ossified, multipartite element resembling the mammalian condition. This discovery pulls back the origin of the distinctive "mammalian" sternum to the base of Theriodontia, significantly extending the temporal range of this morphology. Through a review of sternal morphology across Synapsida, we reconstruct the evolutionary history of this structure. Furthermore, we explore its role in the evolution of mammalian posture, gait, and ventilation through progressive regionalization of the postcranium as well as the posteriorization of musculature associated with mammalian breathing.
Topics: Biological Evolution; Fossils; Locomotion; Respiration; Sternum
PubMed: 35931742
DOI: 10.1038/s41598-022-17492-6 -
Journal of Cardiac Surgery Nov 2022Some would argue that kids aren't just little adults, but what about their sternums? We are reviewing a manuscript by Horriat, McCandless, and colleagues in the Journal...
Some would argue that kids aren't just little adults, but what about their sternums? We are reviewing a manuscript by Horriat, McCandless, and colleagues in the Journal of Cardiac Surgery describing their experience with managing sternal wound infections (SWI) after congenital heart surgery. They report encouraging results in 14 patients who required plastic surgery consultation to manage their sternal wounds. The nature of congenital cardiac abnormalities and the necessary steps to repair them leads to physiologic derangements predisposing patients to SWI. Rates of SWI vary and have been reported at 1.53% in this population. There is little guidance on how the management of the congenital cardiac surgery patient should differ from the adult patient.
Topics: Adult; Cardiac Surgical Procedures; Heart Defects, Congenital; Humans; Plastic Surgery Procedures; Retrospective Studies; Sternum; Surgical Wound Infection
PubMed: 35979689
DOI: 10.1111/jocs.16845 -
Thoracic Cancer Jun 2020Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor composed of dendritic and endothelial cells, and accounts for less than 1% of all vascular tumors. The...
Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor composed of dendritic and endothelial cells, and accounts for less than 1% of all vascular tumors. The tumor may arise from any location in the body, but it has a predilection for veins of the extremities, the liver, bone, and skin. Herein, we report a case of a 43-year-old man who presented with a chest mass accompanied by chest pain. Computed tomography (CT) scan of the chest showed a 3 cm × 2 cm sternal mass in the chest wall. We performed tumor resection and reconstruction of the chest wall. EHE was confirmed via postoperative pathology. The patient underwent postoperative adjuvant radiotherapy, and no evidence of tumor recurrence was discovered during the one-year follow up.
Topics: Adult; Hemangioendothelioma, Epithelioid; Humans; Male; Prognosis; Sternum
PubMed: 32347015
DOI: 10.1111/1759-7714.13454 -
Multimedia Manual of Cardiothoracic... Nov 2023On some occasions, postoperative mediastinal bleeding or right ventricular failure forces surgical teams to pursue a strategy of open-chest management and delayed...
On some occasions, postoperative mediastinal bleeding or right ventricular failure forces surgical teams to pursue a strategy of open-chest management and delayed sternal closure. One notable source of postoperative bleeding is the sternum, either due to medullar bleeding or bone margin oozing, which may be difficult to control. Furthermore, in cases with right ventricular failure or dilatation needing an open-chest strategy, sternal margins might erode and injure the right ventricular anterior wall. We propose a simple but effective sternal protection technique during open-chest management and further delayed chest closure. Using leftover tubing from the cardiopulmonary bypass circuit or a mediastinal 32 Fr drain, both sternal margins are covered and secured with sutures. Moreover, in case of profuse bleeding, a thrombin-derived haemostatic agent can be applied between the bone marrow and the tube for an additional level of haemostasis. The sternal wound is isolated with a latex membrane and covered with transparent sterile adhesive sheets to achieve vacuum sealing.
Topics: Humans; Surgical Wound Infection; Sternum; Heart Failure; Reoperation
PubMed: 37922119
DOI: 10.1510/mmcts.2023.058 -
European Journal of Trauma and... Aug 2021Combined sternal and spinal fractures are rare traumatic injuries with significant risk of spinal and thoracic wall instability. Controversy remains with regard to... (Review)
Review
PURPOSE
Combined sternal and spinal fractures are rare traumatic injuries with significant risk of spinal and thoracic wall instability. Controversy remains with regard to treatment strategies and the biomechanical need for sternal fixation to achieve spinal healing. The present study aimed to assess outcomes of sternovertebral fracture treatment.
METHODS
A systematic review of literature on the treatment of traumatic sternovertebral fractures was conducted. Original studies published after 1990, reporting sternal and spinal healing or stability were included. Studies not reporting treatment outcomes were excluded.
RESULTS
Six studies were included in this review, with a total study population of 98 patients: 2 case series, 3 case reports, and 1 retrospective cohort study. 10 per cent of sternal fractures showed displacement. Most spinal fractures were located in the thoracic spine and were AOSpine type A (51%), type B (35%), or type C (14%). 14 per cent of sternal fractures and 49% of spinal fractures were surgically treated. Sternal treatment failure occurred in 5% of patients and biomechanical spinal failure in 8%. There were no differences in treatment failure between conservative and operative treatment.
CONCLUSION
Literature on traumatic sternovertebral fracture treatment is sparse. Findings indicate that in most patients, sternal fixation is not required to achieve sternal and spinal stability. However, results of the current review should be cautiously interpreted, since most included studies were of poor quality.
Topics: Fractures, Bone; Humans; Retrospective Studies; Spinal Fractures; Sternum; Treatment Outcome
PubMed: 33006034
DOI: 10.1007/s00068-020-01505-y -
Yonsei Medical Journal Dec 2023Clamshell incision offers excellent exposure and access to the pleural spaces and is a standard incision for lung transplantation. However, due to its high sternal...
PURPOSE
Clamshell incision offers excellent exposure and access to the pleural spaces and is a standard incision for lung transplantation. However, due to its high sternal complication rate, the clamshell incision is considered a procedure that requires improvement. In this study, we aimed to investigate the outcomes of transverse sternotomy with clamshell incision in comparison to sternum-sparing bilateral anterolateral thoracotomy (BAT).
MATERIALS AND METHODS
In total, 134 bilateral sequential lung transplants were performed from May 2013 to June 2022. The clamshell incision was used between May 2013 and December 2017, and the BAT was introduced in January 2018. Thirty-four patients underwent clamshell surgery, and 100 patients underwent BAT. We retrospectively compared patient characteristics and perioperative and postoperative outcomes between the two groups.
RESULTS
The clamshell group required an operation time of 745.18±101.76 min, which was significantly longer than that of the BAT group at 669.90±134.09 min (=0.003). The mechanical ventilation period after surgery was 17.26±16.04 days in the clamshell group, significantly longer than the 11.35±12.42 days in the BAT group (=0.028). Intensive care unit stay was also significantly longer in the clamshell group (21.54±15.23 days vs. 15.03±14.28 days; =0.033). In-hospital mortality rates were 26.5% in the clamshell group and 22.0% in the BAT group.
CONCLUSION
Less-invasive lung transplantation via sternum-sparing BAT is a safe procedure with low morbidity and favorable outcomes. Preventing sternal instability enables more stable breathing after surgery, earlier weaning from mechanical ventilation, and faster recovery to routine activities.
Topics: Humans; Retrospective Studies; Lung Transplantation; Sternum; Thoracotomy; Operative Time
PubMed: 37992745
DOI: 10.3349/ymj.2023.0104 -
Internal Medicine (Tokyo, Japan) Jun 2022
Topics: Abdominal Wall; Hernia; Humans; Sternum
PubMed: 34803095
DOI: 10.2169/internalmedicine.8114-21