Article Abstract

The biological approach for sternal replacement: sternochondral allograft transplantation

Authors: Andrea Dell’Amore, Pia Ferrigno, Alessandro Pangoni, Giuseppe Natale, Eleonora Faccioli, Marco Schiavon, Marco Mammana, Giovanni Maria Comacchio, Federico Rea

Abstract

Background: Sternal resection is indicated for different pathological conditions. Sternectomy leaves a large anterior chest-wall defect, and so a correct reconstruction is mandatory to guarantee an optimal respiratory dynamic and to protect the mediastinal organs. This study is aimed to evaluate the results of anterior chest-wall reconstruction using a sternal allograft and to summarize the use of this technique in clinical experience worldwide.
Methods: In the last ten years at our institution, 14 patients have undergone sternectomy followed by anterior chest wall reconstruction using cadaveric cryopreserved sternal allograft mainly for neoplastic disease except one patient whose surgery was performed for complex sternal dehiscence after cardiac operation.
Results: One patient died in the perioperative period. No patients experienced postoperative respiratory failure, surgical site infections, or mechanical failure of the reconstruction. After a median follow-up time of 54 months, there no was occurrence of infection or graft rejection. No respiratory impairment or flail chest occurred in any patients. Eight patients are still alive at the present follow-up time.
Conclusions: Thus far, complications related to graft necrosis or rejection have not been reported on in the literature. In our clinical experience, sternal allograft transplantation has been a safe and reproducible technique providing excellent results. At our institution, allografts have been well-tolerated biologically, even after long term follow-up. We hope that the good results obtained in our experience and in other published series may contribute to the further diffusion of this technique as the first choice in cases of anterior chest wall reconstruction. Further studies are necessary to consolidate the early and long term results.