Safety and Effectiveness of Cadaveric Allograft Sternochondral Replacement After Sternectomy: A New Tool for the Reconstruction of Anterior Chest Wall.
BACKGROUND
Surgical excision with wide margins, prevention of respiratory impairment, and protection of surrounding organs are primary goals in resection and reconstruction of the chest wall. We describe our experience of the use of cadaveric cryopreserved sternal allograft.


METHODS
Eighteen patients underwent surgery. Indications for sternectomy were sternal metastases (n = 9), primary chondrosarcoma (n = 4), sternal dehiscence (n = 2), soft tissue sarcoma (n = 1), malignant solitary fibrous tumor (n = 1), and direct involvement of thymic carcinoma (n = 1). The defect was reconstructed using a cadaveric sternal allograft harvested aseptically, treated with antibiotic solution, and cryopreserved (-80°C). The graft was tailored to fit the defect and fixed in place with titanium plates and screws.


RESULTS
Four patients underwent a total sternectomy, 8 a partial lower sternectomy, and 6 a partial upper sternectomy. In 14 patients, muscle flaps were positioned to cover the graft. During the postoperative course, 1 patient died of pulmonary embolism, 1 had systemic Candida infection, and 1 had surgical revision for bleeding at the site of muscle flap. One patient required removal of a screw on the clavicle 4 months after operation because of partial dislocation. At a median follow-up of 36 months, neither infection nor rejection of the graft occurred; 13 patients are alive without disease, and 4 patients had died. None had local tumor relapse.


CONCLUSIONS
Sternal replacement with cadaveric allograft is safe and effective, providing optimal stability of the chest wall and protection of the surrounding organs, even after extensive chest wall resections. The allograft was biologically well tolerated, allowing a perfect integration into the host.
Thoracic Surgery Unit, Department of Cardiologic, Thoracic, and Vascular Sciences, University Hospital of Padua, Padua, Italy. Electronic address: beppemarulli@libero.it.
Giuseppe
G
Marulli
Thoracic Surgery Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Andrea
A
Dell'amore
Thoracic Surgery Unit, Department of Cardiologic, Thoracic, and Vascular Sciences, University Hospital of Padua, Padua, Italy.
Francesca
F
Calabrese
Thoracic Surgery Unit, Department of Cardiologic, Thoracic, and Vascular Sciences, University Hospital of Padua, Padua, Italy.
Marco
M
Schiavon
Thoracic Surgery Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Niccolò
N
Daddi
Thoracic Surgery Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Giampiero
G
Dolci
Thoracic Surgery Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Franco
F
Stella
Thoracic Surgery Unit, Department of Cardiologic, Thoracic, and Vascular Sciences, University Hospital of Padua, Padua, Italy.
Federico
F
Rea
D000328:Adult; D000368:Aged; D016025:Bone Transplantation; D002102:Cadaver; D015925:Cryopreservation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013249:Sternum / Q000637:transplantation*; D013524:Surgical Flaps; D013899:Thoracic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D035441:Thoracic Wall / Q000601:surgery*; D016896:Treatment Outcome