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Successful three-year outcome in a patient with allogenous sternal bone graft in the treatment of massive
Martin Kaláb1, Jan Karkoška2, Milan Kamínek3
1Department of Cardiosurgery, University Hospital Olomouc and Faculty of Medicine, Palacky University Olomouc, I. P. Pavlova 6, Olomouc 775 20, Czech Republic.
Introduction:
Deep sternal wound infection is a life-threatening complication of longitudinal median sternotomy with extensive loss of sternal bone tissue and adjacent ribs. Wound dehiscence cases with no loss of bone tissue can be resolved via osteosynthesis using titanium plates. Unfortunately, this cannot be used in cases of massive bone tissue loss defects due to insufficient support for fixing the plate material caused by missing bone surface which increasing the risk of osteosynthesis failure. We describe the treatment outcome of sternal dehiscence with massive bone tissue loss defects using an allogenous sternal bone graft.
Case Presentation:
A 62 year old diabetic female was operated for serious sternotomy dehiscence after surgery for aortic valve replacement. There was bone tissue loss and complications. We used allogenous sternal bone graft to close the wound. To monitor the healing of the graft, we performed SPECT/CT examinations of anterior chest wall. We describe the successful healing of the graft with the reduction of defects in osteoblastic activity by 42% 21 months after the graft implantation. The wound was found to be healed on all examinations, The chest wall is stable and the patient reports a good life quality.
Discussion:
An allogenous bone transplant contains no vital bone marrow cells, which eliminates immuno-genetic graft rejection by the patient. Significant osteoblastic activity was thus registered, especially in places where crushed spongy bone had been applied.
Conclusions:
Transplantation of allogenous bone graft sternum in our experience is the best option for treating extensive post-sternotomy defects.
