STRATOS ICU Presentation CHR La Citadelle Liège 280315 short version

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

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Chest wall tumor

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Sternum

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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

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Publication : trauma

Internal fixation of rib cage with Ti clips

Internal fixation of rib cage with Ti bars

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Publication : trauma

Chest CT-preoperative study Chest CT-postoperative study

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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

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Publication : thorax reconstruction

Postoperative CT scan : 3D reconstruction after implantation of Stratos/Dualmesh ( 3 bars )

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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

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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

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Thank you !Training UZ Leuven 18 June 2013