Sternochondral replacement: use of cadaveric allograft for the reconstruction of anterior chest wall.
Sternum
allograft
chest wall
chest wall reconstruction
tumors
Journal
Journal of thoracic disease
ISSN: 2072-1439
Titre abrégé: J Thorac Dis
Pays: China
ID NLM: 101533916
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
entrez:
15
2
2020
pubmed:
15
2
2020
medline:
15
2
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 32055417
doi: 10.21037/jtd.2019.07.82
pii: jtd-12-01-3
pmc: PMC6995821
doi:
Types de publication
Journal Article
Langues
eng
Pagination
3-9Informations de copyright
2020 Journal of Thoracic Disease. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest: The authors have no conflicts of interest to declare.
Références
Ann Thorac Surg. 2011 Oct;92(4):1208-15; discussion 1215-6
pubmed: 21958766
Plast Reconstr Surg. 2002 Sep 15;110(4):1088-91
pubmed: 12198423
Interact Cardiovasc Thorac Surg. 2008 Oct;7(5):858-60
pubmed: 18617553
Plast Reconstr Surg. 2008 May;121(5):353e-355e
pubmed: 18453964
Ann Thorac Surg. 2002 Jun;73(6):1720-5; discussion 1725-6
pubmed: 12078759
Ann Thorac Surg. 2006 Jan;81(1):279-85
pubmed: 16368380
Ann Thorac Surg. 2017 Mar;103(3):898-905
pubmed: 27825689
J Thorac Cardiovasc Surg. 2003 Oct;126(4):1212-4
pubmed: 14566281
Eur J Cardiothorac Surg. 1991;5(7):346-51
pubmed: 1892662
J Thorac Surg. 1947 Aug;16(4):399-406
pubmed: 20256748
Semin Plast Surg. 2011 Feb;25(1):34-42
pubmed: 22294941
Int Orthop. 1993 Nov;17(5):297-9
pubmed: 8125666
Plast Reconstr Surg. 1996 Oct;98(5):804-10
pubmed: 8823018
Arch Surg. 1948 May;56(5):570-8
pubmed: 18889553
Ann Plast Surg. 2004 Jan;52(1):54-60
pubmed: 14676700
J Thorac Dis. 2016 Mar;8(3):490-8
pubmed: 27076945
World J Surg. 2001 Feb;25(2):218-30
pubmed: 11338025
Ann Thorac Surg. 1995 Nov;60(5):1353-8; discussion 1358-9
pubmed: 8526626
J Thorac Cardiovasc Surg. 2007 Apr;133(4):1112-4
pubmed: 17382672
Eur Spine J. 2001 Oct;10 Suppl 2:S96-101
pubmed: 11716023
J Thorac Cardiovasc Surg. 1999 Mar;117(3):588-91; discussion 591-2
pubmed: 10047664
J Thorac Cardiovasc Surg. 2010 Apr;139(4):e69-70
pubmed: 19660292
Surg Clin North Am. 1989 Oct;69(5):965-76
pubmed: 2675354
J Thorac Surg. 1950 Mar;19(3):456-61
pubmed: 15406489
Ann Thorac Surg. 2004 Mar;77(3):1001-6; discussion 1006-7
pubmed: 14992915