title: Autogenous rib grafts for reconstruction of the manubrium after resection: technical refinements and outcomes.
abstract: OBJECTIVE
  Sternal reconstruction after resection is essential for restoring the rigidity of the chest cavity. However, no consensus has been reached regarding the most physiologic or efficacious material for this procedure. We present our clinical experience with autogenous rib grafts for reconstruction of the manubrium after resection and discuss the refinements in this procedure.
  
  
  METHODS
  Twelve consecutive patients with a confirmed diagnosis of a primary neoplasm in the manubrium between March 2003 and August 2013 were analyzed retrospectively. All patients underwent manubrium resection and immediate reconstruction with autogenous rib grafts.
  
  
  RESULTS
  No cases of perioperative mortality were noted. The median operation time was 129 minutes. One patient experienced mild paradoxical movement; the other patients recovered well without any complications. The median follow-up period after surgery was 69 months. Two patients died. One patient with chondrosarcoma died as a result of cardiac disease 26 months after surgery and another patient with non-Hodgkin lymphoma died as a result of local recurrence 6 months after surgery. Computed tomographic scans for the other 10 patients have shown neither dislocation nor abnormality of the transplanted ribs; moreover, no absorption of the grafts or recurrence was noted. None of the patients required prescription analgesics for the pain at the donor site at the 3-month follow-up visit.
  
  
  CONCLUSIONS
  This case series demonstrates the successful use of autogenous rib grafts in the reconstruction of the manubrium after resection. We consider that the reconstruction technique is a safe and effective alternative to a complex problem.
authors.affiliation: Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Guofei
authors.initials: G
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Chengxiao
authors.initials: C
authors.lastname: Liang
authors.affiliation: Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Shen
authors.affiliation: Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Wenshan
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Lijian
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Saibo
authors.initials: S
authors.lastname: Pan
authors.affiliation: Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China. Electronic address: zetszju@yahoo.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Chai
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016025:Bone Transplantation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008371:Manubrium / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D061646:Operative Time; D010027:Osteotomy / Q000009:adverse effects / Q000401:mortality; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012272:Ribs / Q000637:transplantation*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult