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Eur J Cardiothorac Surg 2002;21:371-372
© 2002 Elsevier Science NL

Letter to the Editor

Sternal replacement using composite allograft

Department of Thoracic Surgery, Surgical Clinic, University Medical School of Pecs, H7632 Pecs, Ifjusag u. 13, Hungary

Received 8 November 2001; accepted 18 November 2001.

* Corresponding author. Tel.: +36-30-9273-610
e-mail: mft{at}iseb.pote.hu

We read with interest the article on a new method for stabilization of extended defects by Lampl [1]. His procedure offers an elegant composite alloplastic solution to the problem of skeletal reconstruction for protective and cosmetic reasons and maintaining physiology of ventilatory mechanisms [2]. The wide range of investigations published and pursued for sternal replacement indicates the unresolved nature of the problem. Methyl-methacrylate applied between two layers of a mesh like a sandwich is one of the most popular methods. Our method for sternal replacement is similar to the Lampl method [1], however, the metallic element is replaced with non-absorbable sutures. Following resection of the sternum, the size and the shape of the desired implant is decided on a separate towel. Two 2/2 non-absorbable double-ended polyester sutures (Prolene) were laid down longitudinally in the craniocaudal axis of the neosternum to be. Similar stitches to each horizontal section armed with needles on both ends are also placed on the towel on a back table. Hence, our procedure follows the technology of the iron concrete. The only significant difference is that we apply ties instead of metallic wires and rods used by the builders. The methyl-methacrylate paste is moulded on and around the pre-fabricated net of atraumatic stitches. With the neosternum dried up and rigid enough, the prosthesis is anchored to the ribs and soft tissue using the threaded allograft. When the reinforced concrete-style neosternum is in position, a musculocutaneous flap is created to cover the implant. Seven patients were operated on in the last 2 years using the technique for the following pathologies: malignant desmoid, one case; chronic inflammation, two cases; one solitary secondary due to breast cancer; one direct extension of NSCLC to the sternum; one chondrosarcoma; and one plasmocytoma. In three cases TRAM flaps and in four cases locally mobilised musculocutaneous flaps were applied to cover the implant. The cement ensures the proper rigidity, and the built-in stitches facilitate fixation, allowing an easier attachment to surrounding ribs and soft tissue. We put an emphasis on the close cooperation between the thoracic surgeon and the reconstructive surgeon whose involvement allowed us to avoid compromising the oncological extent of the excision, overriding the inevitable tendency to be conservative [3,4]. Our experience suggests, that the technique presented is simpler than the standard methyl-methacrylate mesh combination reducing the amount and complexity of the implant without compromising the stability of the prosthesis and of the chest cage in consequence and can be an alternative, to the Lampl method [1]. Either of the methods offers a reliable and straightforward technique, which is at least as good as the standard sandwich method. We succeeded in reducing the operative costs without negative impact on efficacy and safety. The method is recommended not only for sternal replacement but also in cases when there is a need for lateral chest wall reinforcement.

References

1. Lampl L. Chestwall resection: a new and simple method for stabilization of extended defects. Eur J Cardiothorac Surg 2001;20:669-673.[Abstract/Free Full Text]
2. Graeber G.M. Chest wall resection and reconstruction. Sem Thorac Cardiovasc Surg 1999;11(3):251-263.[Medline]
3. Hasse J. Surgery for primary, invasive and metastatic malignancy of the chest wall. Eur J Cardiothorac Surg 1991;5:346-351.[Abstract]
4. Mansour K.A., Anderson T.M., Hester T.R. sternal resection and reconstruction. Ann Thorac Surg 1993;55:838-843.[Abstract]

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				B. J. Bibas and R. A. Bibas Operative stabilization of flail chest using a prosthetic mesh and methylmethacrylate. Eur. J. Cardiothorac. Surg., June 1, 2006; 29(6): 1064 - 1066. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thomas F. Molnar Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Molnar, T. F. Articles by Horvath, O. P. Search for Related Content PubMed PubMed Citation Articles by Molnar, T. F. Articles by Horvath, O. P. Related Collections Lung - cancer Chest wall