Giuseppe Marulli1, Andrea Dell'amore2, Francesca Calabrese3, Marco Schiavon3, Niccolò Daddi2, Giampiero Dolci2, Franco Stella2, Federico Rea3. 1. Thoracic Surgery Unit, Department of Cardiologic, Thoracic, and Vascular Sciences, University Hospital of Padua, Padua, Italy. Electronic address: beppemarulli@libero.it. 2. Thoracic Surgery Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy. 3. Thoracic Surgery Unit, Department of Cardiologic, Thoracic, and Vascular Sciences, University Hospital of Padua, Padua, Italy.
Abstract
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.
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.
Authors: Francesco Petrella; Monica Casiraghi; Niccolò Filippi; Riccardo Orlandi; Andrea Alliata; Giorgio Lo Iacono; Luigi Funicelli; Stefania Rizzo; Lorenzo Spaggiari Journal: J Thorac Dis Date: 2020-01 Impact factor: 2.895
Authors: Giuseppe Marulli; Giulia De Iaco; Pia Ferrigno; Angela De Palma; Rosatea Quercia; Debora Brascia; Marco Schiavon; Marco Mammana; Federico Rea Journal: J Thorac Dis Date: 2020-01 Impact factor: 2.895
Authors: Chiara Giraudo; Francesca Nistri; Pia Ferrigno; Giampiero Dolci; Roberto Stramare; Giuseppe Guglielmi; Marco Mammana; Emilio Quaia; Domenica Giunta; Andrea Dell'Amore; Federico Rea Journal: Quant Imaging Med Surg Date: 2021-02