An alternative technique for anterior chest wall reconstruction: the sternal allograft transplantation

Dell’Amore, Andrea; Cassanelli, Nicola; Dolci, Giampiero; Stella, Franco

doi:10.1093/icvts/ivs411

Cited by 37 publications

(46 citation statements)

References 8 publications

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“…In our series, we report on three cases of sternal allograft transplantation; a technique considered experimental up until a few years ago. Sternal allograft transplantation is biocompatible, does not favor the onset of infectious diseases, can receive other synthetic prostheses (titanium bars) and can be tailored on the defect (16)(17)(18). Furthermore, the bone allograft is subjected to the same incorporation process already described for the bone heterograft (19).…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary approach to chest wall resection and reconstruction for chest wall tumors, a single center experience

Scarnecchia¹,

Liparulo²,

Pica³

et al. 2017

J. Thorac. Dis.

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Background: Chest wall resection and reconstruction (CWRR) is quite challenging in surgery, due to evolution in techniques. Neoplasms of the chest wall, primary or secondary, have been considered inoperable for a long time. Thanks to evolving surgical techniques, reconstruction after extensive chest wall resection is possible with good functional and aesthetic results. Conclusions: Surgical planning is most effective when it is tailored to the patient. Specifically, in the treatment of selected chest wall tumors, the multidisciplinary approach is considered mandatory when an extensive demolition is required. Indeed, here, the radical wide en-bloc resection can lead to good results provided that the extent of resection is not influenced by any anticipated problem in reconstruction.

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Section: Discussionmentioning

confidence: 99%

Multidisciplinary approach to chest wall resection and reconstruction for chest wall tumors, a single center experience

Scarnecchia¹,

Liparulo²,

Pica³

et al. 2017

J. Thorac. Dis.

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“…Intraoperatively, the presence of any discrepancy between the allograft and the surgical site of implantation can be easily corrected by, tailoring the bone allograft with a saw and rasp. Recently, new technologies such as 3D-printers and computed based navigation surgery appear to be very promising in preoperative planning and simplification in matching the allograft bone and the recipient's chest wall (44,45). At the end of the operation, a quick, safe and efficient stabilization of the transplanted bone is achieved with titanium plates and screws, usually placed between the allograft and the ribs.…”

Section: A B C Dmentioning

confidence: 99%

Materials and techniques in chest wall reconstruction: a review

et al. 2017

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Extensive chest wall resection and reconstruction are a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeon, plastic surgeon and oncologist. In particular chest wall neoplastic pathology is associated with high surgical morbidity and can result in full thickness defects hard to reconstruct. The goals of a successful chest wall reconstruction are to restore the chest wall rigidity, preserve pulmonary mechanic and protect the intrathoracic organs minimizing the thoracic deformity. In case of large full thickness defects synthetic, biologic or composite meshes can be used, with or without titanium plate to restore thoracic cage rigidity as like as more recently the use of allograft to reconstruct the sternum. After skeletal stability is established full tissue coverage can be achieved using direct suture, skin graft or local advancement flaps, pedicled myocutaneous flaps or free flaps. The aim of this article is to illustrate the indications, various materials and techniques for chest wall reconstruction with the goal to obtain the best chest wall rigidity and soft tissue coverage. by scapula and shoulder girdle, with the exception of defects lower than 4th rib posteriorly, with the tip of the scapula at risk to entrapment (3,12,13). With the increased availability of reconstruction materials, then, and particularly biologic materials, some surgeons proposed the reconstruction of nearly all chest wall defects, with the objective to avoid patient perception of chest wall instability (3,5,13).The primary goals of all chest wall reconstructions are to obliterate dead space, restore chest wall rigidity, preserve pulmonary mechanic, protect intrathoracic organs, provide soft tissue coverage, minimize deformity and allow patients to receive adjuvant radiotherapy if indicated (3,9). Therefore, a multidisciplinary approach, including input from thoracic surgeons, plastic surgeons, neurosurgeons as well as medical and radiation oncologists is essential.Actually several synthetic, biologic, and metallic materials are available to reconstruct the chest wall defects, but each prosthetic material has its own advantages and disadvantages and none have proven to be clearly superior (4,12). In particular, the benefit of each material and technique of reconstruction need to be weighed against to main indicators, as the risk of infection and other major complications that could be fail the reconstructive result.The recent advance in allograft and homograft production have provided new alternatives for restoring structural stability, preventing the infective complications (3,14).We would describe the main reconstructive techniques and materials more adopted on Literature reports and an overview to the incoming future of chest wall reconstruction. Synthetic, biologic and titanium meshesThe use of a metal prostheses was first reported by a French surgeon in 1909 (15), but in the 1940s better-tolerated and easier to use materials, as plastic components emerged, modifying the ...

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“…New materials, more prone to be rapidly incorporated into the host, are currently available for CW reconstruction (15,16): malleable or articulating titanium bars (17), cryopreserved homograft (18,19) and acellular soft tissue patches of bovine, porcine or human derivation (20,21), the latter ones characterized by near-physiological properties.…”

Section: A B C Dmentioning

confidence: 99%

Primary lung tumors invading the chest wall

et al. 2016

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Chest wall (CW) involvement occurs in approximately 5% of all primary lung neoplasms.According to the most recent TNM classification, lung tumors invading CW are classified as T3, and they represent approximately 45% of all T3 lung cancers. The most common clinical symptom at presentation is chest pain (>60%), which is highly specific of CW infiltration (>90%). Dyspnoea and hemoptysis are also described, especially in case of large lesions. A realistic chance to cure locally advanced tumors invading CW is a surgical resection, consisting in the excision of the primary lung cancer along with the involved CW (sometimes an "en-bloc" resection) and an appropriate lymph-nodal dissection. However, such patients are at high-risk of facing postoperative complications; prognosis mainly depends on: (I) the completeness of resection; and (II) the lymph-nodal involvement. Hence, due to these reasons (incidence, symptoms, prognosis, post-operative complications), such category of patients are to be carefully assessed preoperatively and if deemed practicable, surgery should be taken into consideration. In this view, the aim of this paper is to critically review the most recent series of lung tumors invading the CW, with a particular focus on patients' preoperative evaluation, surgical techniques, postoperative complications and overall outcome.

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An alternative technique for anterior chest wall reconstruction: the sternal allograft transplantation

Abstract: The technique of sternal allograft transplantation is simple, reproducible and provides excellent functional and cosmetic results. Further studies including a larger number of patients are needed to understand the biology of the allograft and the long-term results of this technique.

Cited by 37 publications

References 8 publications

Multidisciplinary approach to chest wall resection and reconstruction for chest wall tumors, a single center experience

Multidisciplinary approach to chest wall resection and reconstruction for chest wall tumors, a single center experience

Materials and techniques in chest wall reconstruction: a review

Primary lung tumors invading the chest wall

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