First in Man: Sternal Reconstruction with Autologous Stem Cells.
Sternal nonunion is associated with high morbidity and treated using rigid plate and screw fixation. This is the first reported example of successful sternal reconstruction using adipose-derived stromal vascular fraction (SVF) stem cells in addition to traditional techniques. Mesenchymal stem cells, one component of the SVF, play an important role in bone healing and were therefore used to promote remedial processes in a patient with sternal nonunion. A 3D printed model of the patient's sternum was used for preoperative planning of the plating. Intraoperatively, SVF was isolated using ultrasonic cavitation and previously planned sternal plating was completed. A total of 300 million cells were delivered via both local injection and intravenously before chest closure. The patient's pain dramatically decreased, commensurate with healed areas of nonunion by 3 months and maintained at 6 months postoperatively, supported by three-dimensional computed tomography imaging. Utilizing autologous stem cells from the SVF in conjunction with existing plating techniques may provide an optimal platform to stabilize the sternum and promote bone healing, although additional study is recommended.
From the *Division of Cardiothoracic Surgery, Department of Surgery, †Department of Internal Medicine, ‡Department of Radiology, and §Division of Cardiology, Department of Internal Medicine, Banner University Medical Center, Tucson, Arizona.
Zain
Z
Khalpey
Katherine M
KM
Marsh
Alice
A
Ferng
Irbaz Bin
IB
Riaz
Courtney
C
Hemphill
Kitsie
K
Johnson
Isabel
I
Oliva
Mark
M
Friedman
D050153:Abdominal Fat / Q000166:cytology* / Q000637:transplantation; D000368:Aged; D001860:Bone Plates; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D017102:Fracture Healing; D018460:Fractures, Comminuted / Q000209:etiology / Q000628:therapy; D005599:Fractures, Ununited / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation; D066330:Printing, Three-Dimensional; D019651:Plastic Surgery Procedures / Q000379:methods*; D056346:Sternotomy / Q000009:adverse effects*; D013249:Sternum / Q000293:injuries / Q000601:surgery*; D013524:Surgical Flaps; D014182:Transplantation, Autologous; D014945:Wound Healing