Contact: Will Sansom, 210-567-2579

V. Seenu Reddy, M.D., M.B.A., (right) examines Leroy Lorenz on Aug. 17.
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SAN ANTONIO (Aug. 23, 2011) — Leroy Lorenz’s breastbone failed to heal back together after a coronary artery bypass operation. Donna Lea Anderson’s breastbone was eaten away by a staph infection, a complication of aortic valve surgery. Both lived with chronic pain and disconcerting internal movement for months.

Then they discovered V. Seenu Reddy, M.D., M.B.A., cardiothoracic surgeon with UT Medicine San Antonio. This is the clinical practice of the School of Medicine at The University of Texas Health Science Center San Antonio.

Lorenz and Anderson are among the estimated 400,000 people a year who undergo surgery to bypass arteries, repair heart valves and correct other problems in the chest. These surgeries require dividing the breastbone, which afterward is commonly repaired with stainless steel wire. Healing is normal in most cases, but in up to 3 percent of patients (12,000 a year) the breastbone comes apart. Morbid obesity, poorly controlled diabetes, chronic coughing and vitamin D deficiency often related to osteoporosis increase the risk of this serious complication.

Pioneering a solution
The breastbone, or sternum, anchors the rib cage protecting the heart and lungs. Because of its razor-thin proximity to the heart, many surgeons prefer not to risk nicking the heart to reconstruct the breastbone. Dr. Reddy and other UT Medicine San Antonio physicians are pioneering a corrective surgery that combines three technologies to help these patients. The team has performed 12 of these procedures so far.

“It is very unnatural for a person not to have an intact breastbone,” Dr. Reddy said. “That free-floating movement of a fractured sternum causes chronic pain and psychological problems such as anxiety and depression. These patients are often told nothing can be done.”

Lorenz, a 54-year-old truck driver from Seguin, had his reconstruction in May at CHRISTUS Santa Rosa Hospital - New Braunfels. He hopes to finish rehabilitation soon and get back on the road, a place he hasn’t been since his bypass operation in 2009. After that surgery, he felt a gap inside and shared this with his wife, Leigh Ann. “You could actually put your hand on the bone and move it around and feel all my innards moving,” he said. A chest X-ray confirmed that the breastbone had separated and the wires were broken into several pieces.

Anderson, a 59-year-old writer and lyricist from San Antonio, underwent reconstruction in April at University Hospital in San Antonio. Coag-negative staph destroyed her sternum after her second heart valve operation, causing the top four-fifths of the sternum to be removed. “For a year and a half, my ribs rubbed together and I heard popping whenever I moved,” she said.

Donna Lea and Randy Anderson visit about her recovery at their home.

Blending of expertise
Dr. Reddy, the cardiothoracic surgeon, teams with plastic surgeons Howard Wang, M.D., and Luis Jaramillo, M.D., and radiologist Carlos Restrepo, M.D., to perform these specialized reconstructive surgeries.

Dr. Restrepo, a highly skilled chest radiologist, uses advanced CT imaging to confirm the separation of the sternum. Because every patient is different, it is important to visualize the exact anatomic details that surgery will correct. “CT images also show infection, if it is present, which is a common explanation for why the surgical wound is opening instead of healing,” Dr. Restrepo said.

Aided by digital imaging, Dr. Reddy lifts the sternum off the heart and removes scar tissue on it. The plastic surgeon on the case, Dr. Wang or Dr. Jaramillo, dissects muscle away from the breastbone. With the breastbone exposed, Dr. Reddy reassembles the pieces like a puzzle. He uses two or more flat titanium clamps called Sternal Talons to fix the breastbone in place. A ratchet mechanism is used to pull the sides together.

Dr. Reddy also uses devices that look like bicycle gear chains to stabilize the sternum. Because the two sides of the fracture are jagged and leave gaps when drawn tight, Dr. Reddy applies Kryptonite™ Bone Cement, which provides a bridge for bone cells to migrate across, filling the gaps. Full healing can now take place.

Afterward, a UT Medicine plastic surgeon inserts muscle or fat from the chest or other parts of the body to fill the chest space with soft tissue that has good circulation. This provides protection, blood supply, healing and the ability to deliver antibiotics. “Bone, tendon and vital organs must be covered quickly to prevent dangerous infection,” Dr. Wang said.

Recovering nicely
“I put up with [the unnatural feeling in his chest] for a year and a half, but since Dr. Reddy operated on me I’ve been able to do more stuff around home than I have the last two years,” said Lorenz, the truck driver. “It will be a complete success when I go back to truck driving again. I’ve been working on upper-body rehab because, as the driver, you have to crank down the payload on your truck, and that takes a lot of upper-body strength. I’ve never lost my load going down the road.”

Anderson’s surgery also involved implantation of synthetic bone to replace the large amount of sternum that deteriorated because of infection. “I can move now without hearing the snap, crackle and pop,” Anderson said. “I know my sternum is stabilized and mentally that does so much for me.”

She is now free to enjoy visits by her two small granddaughters. “[Sternum reconstruction] was the only chance for any quality of life for her,” said her husband, Randy Anderson, a procurement manager for Valero Energy in San Antonio.

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UT Medicine San Antonio is the clinical practice of the School of Medicine at the UT Health Science Center at San Antonio. With more than 700 doctors — all faculty from the School of Medicine — UT Medicine is the largest medical practice in Central and South Texas, with expertise in more than 60 different branches of medicine. Primary care doctors and specialists see patients in private practice at UT Medicine’s clinical home, the Medical Arts & Research Center (MARC), located in the South Texas Medical Center at 8300 Floyd Curl Drive, San Antonio 78229. Most major health plans are accepted, and there are clinics and physicians at several local and regional hospitals, including CHRISTUS Santa Rosa, University Hospital and Baptist Medical Center. Call 210-450-9000 to schedule an appointment, or visit www.UTMedicine.org for a complete listing of clinics and phone numbers.