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- Title
Long-term Outcome after Sternochondral Allograft for Anterior Chest Wall Reconstruction.
- Authors
Davari, H. R.; Rahim, M. B.; Mardani, P.; Ershadi, R.; Alavi, S. A. A.; Rafeieyan, S.; Tavakoli, A. A.; Dehghani, S.
- Abstract
Background: Sternum needs reconstruction after wide resection of tumor and occasionally bone defects caused in sternal wound infection after cardiac surgery. A search for the ideal material for chest wall reconstruction continues to challenge thoracic surgeons. Objective: Herein, we present the long-term outcome of bone allograft for sternal reconstruction. Methods: Between January 2012 and August 2015, four patients with sternal bone tumors (including synovial cell sarcoma, myxoid tumor, fibrous tumor, and chondroma), and two patients with wound infection after cardiac surgery, were treated; the defects were reconstructed with bone allograft. After thorough evaluation and taking consent for bone allograft, they were put on the list from a heart beating donor. All operations were done within 1 month with consideration of body size match. Sternum was used after processing by serial culture, freezing and sterilized with ethylene oxide. Allograft was fixed with titanium microfixation and locking screw, after tailoring to fit perfectly the chest wall defect. Bilateral pectoralis major muscles flaps were used to cover the grafts. Results: The operations were uneventful. The first patient with a BMI of 40 kg/m2 developed infection in soft tissue and breast. Her wound was managed with water jet hydrotherapy and negative pressure wound therapy; the allograft was left in place. CT scans taken 6 months to 2 years after the operation from 4 patients were normal with some areas of vacuolization and decreased mineralization. The last patient had prolong seroma formation. Within 9 months, she had two operations; one for refixation of the allograft to both clavicular ends. The second operation was for persistent seroma with partial low allograft stability. Two obese patients with allograft post-CABG were died 35 to 45 days post-op due to cardiac events unrelated to bone allograft and wound healing. Conclusion: This technique is new in chest wall reconstruction. It provides good functional and cosmetic results. Bone allograft is more resistant to infection without immunogenic reaction. Allograft procurement, body size match, and limitation in donation are major issues. Further studies are needed to better understand the biology of such volume bone allograft and long-term results.
- Subjects
STERNUM surgery; TUMOR surgery; TRANSPLANTATION of organs, tissues, etc.
- Publication
International Journal of Organ Transplantation Medicine, 2016, Vol 7, Issue 2, p121
- ISSN
2008-6490
- Publication type
Abstract