title: Reconstruction of massive post-sternotomy defects with allogeneic bone graft: four-year results and experience using the method.
abstract: OBJECTIVE
  Deep sternal wound infection poses a serious problem in cardiac surgery, with an up to 40% risk of mortality. Massive loss of sternum bone tissue and adjacent ribs results in major chest wall instability causing respiratory insufficiency and defects of soft tissue healing. Proposals for managing the situation have been published but the complexity of the issue precludes unequivocal resolution. Capitalizing on orthopaedic experience, we used allogeneic bone graft of sternum as a viable option.
  
  
  METHODS
  We performed the transplantation of allogeneic bone graft in 10 patients. In 9 cases, an allograft of sternum was used and in 1 case an allograft of calva bone. After the primary cardiac surgery, a massive post-sternotomy defect of the chest wall had developed in all 10 patients. Vacuum wound drainage was applied in the treatment of all patients. To stabilize the transverse, titanium plates were used. Bone allograft was prepared by the official Tissue Centre. Crushed allogeneic spongy bone was applied to reinforce the line of contact of the graft and the edges of residual skeleton. In 9 cases, the soft tissue was closed by direct suture of mobilized pectoral flaps. In 1 case, V-Y transposition of pectoral flap was performed.
  
  
  RESULTS
  In 6 cases, healing of the reconstructed chest wall occurred without further complications. In 3 cases, additional re-suture of the soft tissues and skin in the lower pole of the wound was necessary. Excellent chest wall stability along with the adjustment of respiratory insufficiency and good cosmetic effect was achieved in all cases. In 1 case, severe concomitant complications and no healing of the wound resulted in death within 6 months after the reconstruction. Median follow-up of all patients in the series was 14.1 months (1-36 months). In 4 patients, scintigraphy of the chest wall was performed.
  
  
  CONCLUSIONS
  Our existing results show that allogeneic bone graft transplantation is a promising and easily applied method in the management of serious tissue loss in sternal dehiscence with favourable functional and cosmetic effects. The relatively small number of patients with such severe healing complications of sternotomy however puts critical limits to a more detailed comparison with other practices and evaluation of long-term results.
authors.affiliation: Department of Cardiosurgery, University Hospital Olomouc and Faculty of Medicine, Palacky University Olomouc, Olomouc, Czech Republic martin.kalab@email.cz.
authors.forename: Martin
authors.initials: M
authors.lastname: Kaláb
authors.affiliation: National Cell and Tissue Centre, Brno, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Karkoška
authors.affiliation: Department of Nuclear Medicine, University Hospital Olomouc and Faculty of Medicine, Palacky University Olomouc, Olomouc, Czech Republic.
authors.forename: Milan
authors.initials: M
authors.lastname: Kamínek
authors.affiliation: National Cell and Tissue Centre, Brno, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Matějková
authors.affiliation: Department of Cardiosurgery, University Hospital Olomouc and Faculty of Medicine, Palacky University Olomouc, Olomouc, Czech Republic.
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Slaměníková
authors.affiliation: Department of Cardiosurgery, University Hospital Olomouc and Faculty of Medicine, Palacky University Olomouc, Olomouc, Czech Republic.
authors.forename: Aleš
authors.initials: A
authors.lastname: Klváček
authors.affiliation: Department of Cardiosurgery, University Hospital Olomouc and Faculty of Medicine, Palacky University Olomouc, Olomouc, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Šantavý
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D010369:Pectoralis Muscles / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012086:Reoperation; D056346:Sternotomy / Q000009:adverse effects* / Q000401:mortality; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D013536:Suture Techniques; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Allogeneic bone graft of sternum; Deep sternal wound infection; Massive post-sternotomy defect; Sternotomy