External Chest Brace For Clam Shell Sternal Instability Following Bilateral Sequential Lung Transplant: A Case Series

Background: A common surgical incision for bilateral lung transplantation is the 'clam shell' approach via bilateral anterior thoracotomies and a transverse sternotomy to allow for the replacement of the lungs sequentially (Macchiarini et al, 1999; Karnak et al, 2006). Although popular, the clam shell incision (CSI) can be associated with significant postoperative pain, bony overriding or disruptions at the sternotomy site in 32%-60% of patients (Macchiarini et al, 1999; Venuta et al, 2003; Richards et al, 2004; Karnak et al, 2006). The subsequent non-union and sternal instability cause significant morbidity and mortality with reported rates of 34% and 26%, respectively (Karnak et al, 2006).Content: The literature revealed a myriad of surgical approaches to this clinical problem, but a paucity of conservative external chest bracing solutions for transverse sternal instability. This case series describes the clinical management of three post bilateral sequential lung transplant (BSLTX) recipients that necessitated the design and development of a custom made external chest orthosis (brace) with input from a multidisciplinary team.Conclusion: This brace is offered as a solution for transverse sternal instability and pain following lung transplantation.