Autogenous rib grafts for reconstruction of the manubrium after resection: Technical refinements and outcomes

Zhang, Guofei; Liang, Chengxiao; Shen, Gang; Li, Wenshan; Huang, Lei; Pan, Saibo; Chai, Ying

doi:10.1016/j.jtcvs.2014.07.093

Cited by 7 publications

(4 citation statements)

References 21 publications

(21 reference statements)

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“…In general, autologous bone-free flap is restricted by donor bone availability and surgical trauma. 17,18 Autologous tissues, such as bone grafts, have been proposed for sternal reconstruction with a significant rate of success, 19,20 but for smaller defects. For these reasons, we opted for titanium bars.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique

Baccarani,

Filosso,

Marra

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Sternal tumors are rare, comprising only 0.94% of all bone tumors, with the majority being sarcomas. An extensive composite defect is often the result of surgical resection. Reconstruction of this anatomical area is a challenge for plastic surgeons. Reconstruction must fulfil two different tasks: restoration of soft tissues and stabilization of the chest wall. Both are well defined, and many techniques have been historically proposed. Methods: We present the case of a 66-year-old man affected by sternal metastasis of lung non-small cell carcinoma with sarcomatoid features. After wide tumor resection, a large defect was created. Results: The patient underwent a complex multilayer reconstruction that combined multiple techniques: Gore DualMesh to reconstruct the pericardial plane and protect the heart muscle, omental flap to facilitate integration of the mesh, titanium bars to recreate chest wall stability, and bilateral pectoralis muscle flaps to cover hardware. This multilayer reconstruction was named the “lasagna technique.” Conclusions: Due to the rarity of primary malignancies of the sternum, it is difficult to standardize a therapeutic approach. For this reason, it is necessary to customize the surgical treatment by combining several techniques and materials. Our lasagna technique may be considered a valuable option in treating these complex reconstructive cases.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique

Baccarani,

Filosso,

Marra

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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show abstract

“…In the area of plastic and reconstructive surgery, autologous rib cartilage, illum or other bone tissue were used for repair trachea ( 21 ), nose ( 22 ) and auricle ( 23 ). Zhang et al ( 24 ) used autologous rib grafts to reconstruct the defected chest wall after manubrium tumors resection, and extubation finished within 24 hours and no perioperative mortality occurred during treatment. However, for this technique, harvesting ribs had a risk of chest wall malacia, which might lead to abnormal respiration.…”

Section: Discussionmentioning

confidence: 99%

Autologous ilium graft combination with Y-shaped titanium plate fixation for chest wall reconstruction after resection of primary sternal tumors—a clinical study from three institutions

Xu¹,

Dou²,

Zhao³

et al. 2020

Transl Cancer Res TCR

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Background:The technique for anterior chest wall reconstruction after resection of primary sternal tumors (PST) still continue to evolve.Methods: A total of 12 PST patients from three hospitals who underwent en-bloc resection were included in our study. After finishing sternum resection, autologous iliac bone combined with Y-shaped titanium plate were applied to rebuild the anterior chest wall. Postoperative outcomes were analyzed.Results: There were 10 different types of tumors located in manubrium (6 cases), sternum body (4 cases) and Louis's angle (2 cases) in our research. For these patients, the median resected tumor size and the area of defect after sternal resection were 279.0 cm 3 and 215.0 cm 2 , respectively. The mean operative time was 299.2±65.2 min and intra-operative blood loss was 431.2±213.0 mL. Mean duration of drainage was 9.9±2.6 days.In their perioperative period, significant circulatory and respiratory complications occurred in 8 patients.Postoperative chest X-ray and tridimensional CT images showed autogenous reconstruction of the sternum and titanium in good position. No side effects were observed 6-12 months post reconstructive surgery, but one patient suffered from anchor loss and prosthesis migration. Y-shaped titanium plates from two patients were separately removed at 24 and 26 months when the reconstructive sternum integrated with skeleton anterior chest wall well.Conclusions: Our study demonstrates the safety and feasibility of this new technique for anterior chest wall reconstruction after sternectomies.

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“…Autologous bone transplantation is restricted by donor bone acquirement and surgical trauma (5-7). Allogenic bone transplantation needs to deal with risks of allograft infection, necrosis, and absorption, aside from requirements in preservation (5,(8)(9)(10). The traditional titanium plates cannot be overlapped to offer mechanical support on two dimensions (11,12).…”

Section: Discussionmentioning

confidence: 99%

Sternal resection and reconstruction with a multi-functional modular prosthesis

Wang¹,

Chen²,

Shi³

et al. 2019

Curr Chall Thorac Surg

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Reconstruction for a large area of sternal defect is challenging. The available sternal reconstruction techniques and materials have their limitations. We designed a modular sternal reconstruction system made of titanium alloy. This system was applied to a patient who received partial sternal resection for well-differentiated chondrosarcoma of the sternum. The sternal neoplasm measured 80×70 mm 2 . After resection of most of the sternal body and adjacent ribs, standard modules of adequate types and sizes were chosen and assembled during operation. The operation lasted for 240 min, with an intraoperative blood loss of 100 mL. The patient was followed up for 32 months, while the prosthesis remained stable, with no signs of infection or looseness.

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Autogenous rib grafts for reconstruction of the manubrium after resection: Technical refinements and outcomes

Abstract: This case series demonstrates the successful use of autogenous rib grafts in the reconstruction of the manubrium after resection. We consider that the reconstruction technique is a safe and effective alternative to a complex problem.

Cited by 7 publications

References 21 publications

Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique

Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique

Autologous ilium graft combination with Y-shaped titanium plate fixation for chest wall reconstruction after resection of primary sternal tumors—a clinical study from three institutions

Sternal resection and reconstruction with a multi-functional modular prosthesis

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