This document discusses the STRATOSTM system for surgical stabilization of chest wall injuries and deformities. It was developed in collaboration with CHU Strasbourg using pure titanium implants. The system is indicated for deformities, trauma, reconstructive surgery, and sternum stabilization. Several publications demonstrate its effectiveness in trauma stabilization, large chest wall reconstruction, and late postcardiotomy sternal dehiscence. Experience at CHU Strasbourg in 34 patients showed no mortality, low morbidity, and short median ventilation, ICU stay, and hospital stay, indicating the STRATOSTM system enables effective stabilization and mobilization of chest wall injury patients.

1. STRATOSTM
Strasbourg Thoracic
Osteosynthese
System
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2. STRATOSTM : the origin
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Developed in collaboration with CHU Strasbourg

3. Indications
 Deformities
 Trauma
 Reconstructive surgery
 Sternum
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4. Deformities : Pectus Excavatum
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5. Chest wall tumor
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6. Sternum
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7. Trauma
 Surgical stabilization of
multiple rib fractures (
« Flail Chest » )
 Surgical stabilization of
single rib fractures
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8. Multiple rib fracture – Flail Chest
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9. Single fracture
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10. 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
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11. STRATOSTM : pure Ti implants
3 elements per stage :
 1 connecting bar
 2 rib clips
2 fixation points
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12. 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
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13. STRATOSTM : pure Ti implants
Codification system :
 Blue : correction
 Yellow : reconstructive surgery,
trauma
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14. STRATOSTM : pure Ti implants
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15. 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.
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16. 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
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17. Publication : trauma
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18. 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
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19. Publication : trauma
Open reduction of fractured ribs
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20. Publication : trauma
Internal fixation of rib cage with Ti clips Internal fixation of rib cage with Ti bars
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21. Publication : trauma
Chest CT-preoperative study Chest CT-postoperative study
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22. 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.
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23. 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
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24. 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
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25. Publication : thorax reconstruction
Dualmesh is sewn around the defect under maximum tension
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26. Publication : thorax reconstruction
Postoperative CT scan : 3D reconstruction after implantation of
Stratos/Dualmesh ( 3 bars )
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27. Publication : sternal closure
Jayle C. and al (2013). Late
Postcardiotomy Sternal Dehiscence : A
simple Approach Using Stratos® System.
J Card Surg;XX: 1-3.
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28. 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
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29. 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
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30. Publication : sternal closure
Ti implants in place and reduction forceps approximating the right and left
side of sternum
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31. 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
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32. 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
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33. 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
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34. 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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35. Experience in CHU Strasbourg
Patients characteristics Number ( range )
Patients
Male
Female
34
23
11
Median age ( years ) 65 ( 18-84 )
Comorbidities
Cardiovascular
COPD
Metabolic disease
21
18
9
13
Flail chest 11
Bilateral rib fractures 23
Average number of rib fractures 10.4 ( 3-29 )
Associated lesions 20
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36. 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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37. Thank you !
Training UZ Leuven 18 June 2013