Sternochondral replacement: use of cadaveric allograft for the reconstruction of anterior chest wall

Abstract

Background: Sternum may be involved by different diseases such as trauma, infection after cardiac surgery, tumors (primary and secondary) or chest wall deformities. Surgical excision with a safety margin is the primary goal after sternal resection for tumors, prevention of respiratory impairment due to flail chest and deformity and protection of surrounding organs are other important aims. Various techniques and materials have been used for this operation. We describe the use of cadaveric sternal allograft to reconstruct the chest wall in fourteen patients.Methods: Between October 2008 and February 2017, five males and nine females underwent surgical procedure because of primary sternal neoplasm, single-site metastatic disease, neuroendocrine thymic carcinoma and sternal dehiscence after cardiac surgery.Results: Fourteen sternectomy were undertaken. A muscle flap of pectoralis major was prepared to cover the graft in 9 patients. Adjuvant chemotherapy and radiotherapy were performed after surgery in three patients. No postoperative complications happened in 11 cases (84.6%). One (7.1%) patient died 9 days after surgery because of pulmonary embolism. Two patients (15.4 %) had complications: one presented fever caused by systemic candidiasis and one had a muscle flap bleeding. Hospitalization median time was 11 days (range, 6-31 days). At follow up, 7 patients were alive in absence of disease, 1 patient is alive with recurrence, 6 patients died but nor infection neither rejection of the graft happened. No respiratory impairment or flail chest were registered in any patients. Conclusions:This technique for sternal replacement in our experience can be considered safe with long term results, providing optimal chest wall stability. The allograft resulted well-tolerated permitting an optimal graft integration in the host.

Evaluation of Clinical Performance of TiNi-Based Implants Used in Chest Wall Repair after Resection for Malignant Tumors

“…Our surgical treatment of chest wall tumors accords well, in all cases, with an approach on the reconstruction procedure of a post-excision defect in the sternocostal framework reported in [ 1 , 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Artificial rib constructs for thoracic osteosynthesis prepared pursuant to a 3D model were a proper fit when the defect was being reconstructed and did not require any intraoperative correction ( Figure 1 ), and thus the surgery time was shortened, as indicated in Table 3 .…”

“…To date, the global clinical practice dictates an attitude towards reconstructive procedures, which suggested a tolerable postoperative complication rate. The mainstay of chest wall surgical treatment clearly shows that to eliminate an extensive post-excision defect of the integumentary soft tissues, it is recommended to adhere to the use of non-free skin/fatty tissue, skin/muscle, and muscle flaps, as well as the greater omentum on a pedicle [ 1 , 3 , 8 , 9 , 10 ]. However, to reconstruct the sternocostal framework, the use of synthetic materials and implants comes to the fore.…”

Expert consensus on resection of chest wall tumors and chest wall reconstruction

“…(I) To provide a rigid structure and a complete covering of the defect of the chest wall; (II) Its capability of integration with the host patient's living tissue, thanks to their osteoconductive and osteoinductive capacities by acting as a scaffold for the genesis of new bone; (III) To reduce the risk of infection and of immunologic reaction (92). Alberto Sandri: Most surgeons agree that defects >5 cm in diameter or including >4 ribs should be reconstructed due to cited above risks.…”

Reconstruction of Chest Wall by Cryopreserved Sternum Allograft After Resection of Sternal Hemangioma: A Case Report

“…Methyl methacrylate meshes and sandwiches, polytetrafluoroethylene (PTFE), and polypropylene patches are routinely used in thoracic surgery for reconstruction. The disadvantages of these prosthetic materials are the risk of infection, dislodgement, and long-term complications, including changes in thoracic morphology and function in pediatric patients ( 10 ). Metallic materials, such as titanium clips, plates, and moldable multi-hole plates, have been used for the stabilization of the chest wall ( 11 , 12 ) and may have the same complications as other prosthetic materials.…”