Marulli Giuseppe, De Iaco Giulia, Ferrigno Pia, De Palma Angela, Quercia Rosatea, Brascia Debora, Schiavon Marco, Mammana Marco, Rea Federico
Thoracic Surgery Unit, University Hospital of Bari, Bari, Italy.
Thoracic Surgery Unit, University Hospital of Padova, Padova, Italy.
J Thorac Dis. 2020 Jan;12(1):3-9. doi: 10.21037/jtd.2019.07.82.
Sternum may be involved by different diseases such as trauma, infection after cardiac surgery, tumors (primary and secondary) or chest wall deformities. Surgical excision with a safety margin is the primary goal after sternal resection for tumors, prevention of respiratory impairment due to flail chest and deformity and protection of surrounding organs are other important aims. Various techniques and materials have been used for this operation. We describe the use of cadaveric sternal allograft to reconstruct the chest wall in fourteen patients.
Between October 2008 and February 2017, five males and nine females underwent surgical procedure because of primary sternal neoplasm, single-site metastatic disease, neuroendocrine thymic carcinoma and sternal dehiscence after cardiac surgery.
Fourteen sternectomy were undertaken. A muscle flap of pectoralis major was prepared to cover the graft in 9 patients. Adjuvant chemotherapy and radiotherapy were performed after surgery in three patients. No postoperative complications happened in 11 cases (84.6%). One (7.1%) patient died 9 days after surgery because of pulmonary embolism. Two patients (15.4%) had complications: one presented fever caused by systemic candidiasis and one had a muscle flap bleeding. Hospitalization median time was 11 days (range, 6-31 days). At follow up, 7 patients were alive in absence of disease, 1 patient is alive with recurrence, 6 patients died but nor infection neither rejection of the graft happened. No respiratory impairment or flail chest were registered in any patients.
This technique for sternal replacement in our experience can be considered safe with long term results, providing optimal chest wall stability. The allograft resulted well-tolerated permitting an optimal graft integration in the host.
胸骨可能会受到不同疾病的影响，如创伤、心脏手术后感染、肿瘤（原发性和继发性）或胸壁畸形。对于肿瘤患者，胸骨切除术后的主要目标是进行安全切缘的手术切除，预防连枷胸和畸形导致的呼吸功能障碍以及保护周围器官也是其他重要目标。该手术已采用了各种技术和材料。我们描述了在14例患者中使用尸体胸骨同种异体移植来重建胸壁的情况。
2008年10月至2017年2月期间，5名男性和9名女性因原发性胸骨肿瘤、单部位转移性疾病、神经内分泌胸腺癌以及心脏手术后胸骨裂开接受了手术。
共进行了14例胸骨切除术。9例患者制备了胸大肌肌瓣以覆盖移植物。3例患者术后进行了辅助化疗和放疗。11例（84.6%）患者未发生术后并发症。1例（7.1%）患者术后9天因肺栓塞死亡。2例患者（15.4%）出现并发症：1例因全身性念珠菌病发热，1例肌瓣出血。中位住院时间为11天（范围6 - 31天）。随访时，7例患者无病存活，1例患者复发存活，6例患者死亡，但未发生感染或移植物排斥反应。所有患者均未出现呼吸功能障碍或连枷胸。
根据我们的经验，这种胸骨置换技术长期效果良好，可认为是安全的，能提供最佳的胸壁稳定性。同种异体移植物耐受性良好，能在宿主中实现最佳的移植物整合。
