Frontal sinus obliteration with beta-tricalcium phosphate .

Autogenous materials are considered the gold standard when indicated for frontal sinus obliteration; however, alloplastic alternatives obviate the need for a second surgical site, eliminate donor site morbidity, and reduce operating room time. A variety of different alloplastic materials have been used for this purpose, but no report to date has described the use of pure beta -tricalcium phosphate synthetic bone. This case report describes the technique and successful use of this product for frontal sinus obliteration in a severely comminuted anterior table and nasofrontal duct injury. The product warrants consideration as a viable alternative to standard autogenous and alloplastic substrates for frontal sinus obliteration.

Composite plate and wire fixation for complicated sternal closure.

Many techniques have been described to achieve closure of complicated median sternotomy wounds. The standard method of closure uses stainless steel wiring of the sternal halves; however, in complicated sternal closures, sternal cut-through and wire failure can occur. Recent literature advocates the use of fixation plates that achieve bony union, with plating across the median sternal osteotomy site as a singular method. We describe a technique of composite closure using titanium fixation plates to buttress the sternum in combination with circumferential stainless steel wires. This composite technique has been used in 6 patients with complicated sternal closures. Successful wound closure without complication was achieved in all cases. The technique and the clinical series with an illustrative example are presented. The use of plate and wire fixation represents an alternate method to conventional techniques to achieve sternal closure, stability, and uncomplicated wound healing in these difficult-to-manage cases.