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STRATOSTM
Strasbourg Thoracic
Osteosynthese SystemStaff Meeting Réanimation CHR La Citadelle Liège 28/03/14
STRATOSTM : the originStaff meeting CHR La Citadelle Liège 28/03/14
Developed in collaboration with CHU Strasbourg
Indications
Deformities Trauma Reconstructive
surgery Sternum
Staff meeting CHR La Citadelle Liège 28/03/14
Deformities : Pectus Excavatum
Staff meeting CHR La Citadelle Liège 28/03/14
Chest wall tumor
Staff meeting CHR La Citadelle Liège 28/03/14
Sternum
Staff meeting CHR La Citadelle Liège 28/03/14
Trauma Surgical stabilization
of multiple rib fractures ( « Flail Chest » )
Surgical stabilization of single rib fractures
Staff meeting CHR La Citadelle Liège 28/03/14
Multiple rib fracture – Flail Chest Staff meeting CHR La Citadelle Liège 28/03/14
Single fractureStaff meeting CHR La Citadelle Liège 28/03/14
STRATOSTM : pure Ti implants
Excellent tissue compatibilty
Chemically inert and corrosion-free
High pliability easy and precise adaptation to rib contours
Minimal rebound Static free X-Ray, CT and
MRI
Staff meeting CHR La Citadelle Liège 28/03/14
STRATOSTM : pure Ti implants
3 elements per stage : 1 connecting bar 2 rib clips 2 fixation points
Staff meeting CHR La Citadelle Liège 28/03/14
STRATOSTM : pure Ti implants
Ti rib clips standard and XL : 22,50 and 450
Connecting bars partially serrated : blue 150 mm 190 mm 230 mm
Connecting bars completely serrated : yellow 190 mm 230 mm
Staff meeting CHR La Citadelle Liège 28/03/14
STRATOSTM : pure Ti implants
Codification system :
Blue : correction
Yellow : reconstructive surgery, trauma
Staff meeting CHR La Citadelle Liège 28/03/14
STRATOSTM : pure Ti implantsStaff meeting CHR La Citadelle Liège 28/03/14
Publication : trauma
Moreno P. and al (2010). Surgical fixation of rib fractures with clips and titanium bars (StraTosTM System). Preliminary experience. CIR ESP 2010;88(3): 180-186.
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : trauma Background : the purpose of the study is to assess
the usefulness of Ti rib bars and clips in stabilizing rib fractures
Methods : 22 patients
patients with unstable chest : 13 patients with pain / instability due to rib fractures : 6 patients with significant traumatic deformities : 3
open reduction and internal fixation
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : trauma
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : trauma
Results : The majority of the patients were extubated immediately
after surgery All patients showed a significant improvement or
disappearance of pain after surgery 55 % of patients had returned to work or normal life after
3 months
Conclusion : the use of Ti rib bars and clips give good clinical results, are easy to apply and have few complications
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : trauma
Open reduction of fractured ribs
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : trauma
Internal fixation of rib cage with Ti clips
Internal fixation of rib cage with Ti bars
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : trauma
Chest CT-preoperative study Chest CT-postoperative study
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : thorax reconstruction
Berthet JP. and al (2011). Titanium Plates and Dualmesh : A Modern Combination for Reconstructing Very Large Chest Wall Defects. The Annals of Thoracic Surgery, 91 : 1706-1719.
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : thorax reconstruction Background : reconstruction of large full-thickness
chesr wall defects after resection of T3/T4 non-small cell lung carcinomas or primary chest wall tumors determines postoperative morbidity
Methods : 19 patients ePTFE shaped to match chest wall defect and sewed
under maximum tension ePTFE placed close to the lung and fixed onto the bony
framwork and onto the Ti plate
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : thorax reconstruction
Results : complete R0 resection with removal of 3-9 ribs including
the sternum in 7 cases 1-4 Ti bars
Conclusion : easy and safe one-staged procedure for major chest wall defects
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : thorax reconstruction
Dualmesh is sewn around the defect under maximum tension
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : thorax reconstruction
Postoperative CT scan : 3D reconstruction after implantation of Stratos/Dualmesh ( 3 bars )
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : sternal closure
Jayle C. and al (2013). Late Postcardiotomy Sternal Dehiscence : A simple Approach Using Stratos® System. J Card Surg;XX: 1-3.
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : sternal closure Background : postcardiotomy sternal dehiscence is
reported to occur in 0.4 to 4 % of median sternotomies mostly as a result of anterior mediastinis. Treatment remains challenging because of chronic pain and respiratory dysfunction
Methods : 5 patients : mean age 65 y. paradoxical chest wall movement and chronic pain
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : sternal closure
Results : 2 Ti bars are mounted on the third and fifth ribs pectoral muscles are approximated at the midline and the
wound is closed in layers respiratory functional status and pain were immediately
improved no recurrence of dehiscence and no septic recurrence
were observed
Conclusion : simple technique that avoids re-entry into the retrosternal space
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : sternal closure
Ti implants in place and reduction forceps approximating the right and left side of sternum
Staff meeting CHR La Citadelle Liège 28/03/14
Publication : sternal closure
(A) Final appearance of the repaired sternal dehiscence with the Stratos® system on chest roentgenogram(B) 3D postoperative CT scan with 2 Ti bridges revealing no interference with CT
Staff meeting CHR La Citadelle Liège 28/03/14
Surgical stabilization : short term advantages
Exploration of the chest : drainage of hemothorax Identification of associated injuries
Restoration of chest wall rigidity : relieve of pain chest wall motion effective cough
Immdediate mobilization of the patient : no prolonged intubation no prolonged bed rests
Staff meeting CHR La Citadelle Liège 28/03/14
Surgical stabilization : long term advantages
Decrease of long term complications : chest wall deformity and fibrothorax pseudarthrosis chronic pain restrictive respiratory failure
Social consequences : decrease of ICU and hospital stays earlier autonomy and return to work
Staff meeting CHR La Citadelle Liège 28/03/14
Targets for rib osteosynthesis Severe trauma :
Flail chest Chest wall impactation Staged rib fractures
Benign trauma : single rib fractures COPD poor pain control
Staff meeting CHR La Citadelle Liège 28/03/14
Experience in CHU StrasbourgPatients characteristics Number ( range )Patients
MaleFemale
342311
Median age ( years ) 65 ( 18-84 )Comorbidities
CardiovascularCOPDMetabolic disease
2118913
Flail chest 11Bilateral rib fractures 23Average number of rib fractures 10.4 ( 3-29 )Associated lesions 20
Staff meeting CHR La Citadelle Liège 28/03/14
Experience in CHU Strasbourg
Results Number %
Mortality 0 0
Morbidity 8 23
Mechanical ventilation ( d. )
2.5 ( 0-26 ) Med 0
ICU stay 5.0 ( 0-35 ) Med 0
Hospital stay 15.2 ( 3-48 ) Med 12
Staff meeting CHR La Citadelle Liège 28/03/14
Thank you !Training UZ Leuven 18 June 2013