I have made several changes in my overall technique.
I have enclosed a picture demonstrating my new rib re-attachment technique.
I have decided to change this several months ago because I have had approximately 12 patients over the past several years that developed a chronic draining fistula from the stainless steel plate that I was using to re-attach the rib. This was a problem that did not occur often, but when it did, it was a nusiance. In fact, I have had several patients that required multiple interventions to debride the fistulous tract.
In the past, I used stainless steel 3 hole plate and a non-absorbable Fiberwire suture to fix the plate over the transected rib. This did provide stability but…..
Now I use only ABSORBABLE sutures for the rib attachment as well as the pericostal suture.
I start by placing a No. 2 pericostal suture, in a figure of 8 fashion, through the top and bottom ribs ,not around the ribs.
Before tying this, I will then use a 0 vicryl suture.
This is placed forehand through the anterior aspect of the sternum, entering the cortex and exiting the medulla. Then I enter the medulla of the detached rib segment and out through the cortex.(1)
Once this is done, I will tie the large pericostal suture which is initially place around the ribs.
Then I will use the 0 vicryl suture and pass it forehand into the detached rib. After exiting the rib, I will pass it forehand into the top rib (2).
Then I will backhand the same suture and pass it from undersurface of the sternum and out through its anterior table.
At this point I will tie this suture.
Occasionally I will pass it one more time around the bottom and top ribs to provide additional stability.
This really works and I have now done this on over 100 cases without problems!