Reconstruction of massive post-sternotomy defects with allogeneic bone graft: four-year results and experience using the method

Kaláb, Martin; Karkoška, Jan; Kamínek, Milan; Matějková, Eva; Slaměníková, Zuzana; Klváček, Aleš; Šantavý, Petr

doi:10.1093/icvts/ivv322

Cited by 15 publications

(17 citation statements)

References 22 publications

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“…Bone grafts act as a structure for osteoprogenitor cells and bone growth. These materials are already extensively used in orthopedic and maxillofacial surgery with very good results (35)(36)(37)(38). The main limitation of bone autografts concerns the amount of bone that can be harvested and thus implanted in the thoracic site of reconstruction.…”

Section: Titanium Platesmentioning

confidence: 99%

“…The main limitation of bone autografts concerns the amount of bone that can be harvested and thus implanted in the thoracic site of reconstruction. In the last years, a large numbers of case reports described the use of bone allografts also for chest wall reconstruction (14,35,(39)(40)(41) (Figure 12). In 2010, the Padua Group reported the first case of allograft sternochondral replacement after sternectomy for chondrosarcoma (14).…”

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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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Section: Titanium Platesmentioning

confidence: 99%

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confidence: 99%

Materials and techniques in chest wall reconstruction: a review

et al. 2017

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“…In cardiac surgery, deep sternal wound infections secondary to failed sternotomy have a 40% mortality rate. 5 These infections can cause significant bone loss in the chest wall and require reconstruction. Defects that do not undergo reconstruction put the patient at risk of right ventricular injury and impair respiratory function, requiring the extended use of mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…Defects that do not undergo reconstruction put the patient at risk of right ventricular injury and impair respiratory function, requiring the extended use of mechanical ventilation. 1 , 5 …”

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Sternal Tumor Resection and Reconstruction Using Iliac Crest Autograft

Drinnon

Sherali

Cox

2020

Plastic and Reconstructive Surgery - Global Open

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Background: Primary malignant tumors of the sternum are rare among bone tumors. Even with radical resection, the survival rate for sternal tumors remains low. Resection often results in significant bone defects in the chest wall, and reconstruction must provide adequate protection for pulmonary and respiratory structures. Flexible materials have historically been used for sternal reconstructions following failed sternotomies in cardiac surgery. Although these have had some success, they fail to provide adequate support for patients undergoing reconstruction secondary to tumor resection, who are otherwise healthy and active. Although rigid materials offer greater protection, they frequently cause chronic pain and respiratory complications. More recently, bone grafts have been used to reconstruct sternal defects, and the limited published reports are promising. Methods: We present the case of a patient diagnosed with an extramedullary solitary bone plasmacytoma who underwent a sternal resection and reconstruction with an autogenous bone graft taken from the iliac crest and secured in place with 5 plates (3 sternal and 2 mandibular). Results: At 9-month follow-up, bone marrow biopsy showed no evidence of multiple myeloma. X-ray, computed tomography, and Pulmonary Function Test (PFT) scans confirmed graft stability, and the patient has returned to normal activities. Conclusions: Sternal resection and reconstruction is an effective method for treating extramedullary solitary plasmacytoma when radiation is ineffective. In cases of significant segmental defects, iliac crest bone graft may be a viable option for repairing sternal defects following tumor resection.

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