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Complex sternal and rib reconstruction with allogeneic material.

Charles Miles Maliska Iii1, Robert Lloyd Archer2, Sharon Kaye Tarpley3

  • 1Department of Surgery, University of Oklahoma College of Medicine-Tulsa, Tulsa, OK, USA.

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Summary

Sternal reconstruction using a donated sternum and ribs, enhanced with stem cells and muscle flaps, offers a new single-stage solution. This innovative approach successfully restored chest wall integrity and improved patient quality of life.

Keywords:
Adipose derived stromal vascular fraction cellsFractures, malunitedReconstructive surgical proceduresSternumThoracic surgical procedures

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Area of Science:

  • Regenerative Medicine
  • Thoracic Surgery
  • Tissue Engineering

Background:

  • Sternal malunion or loss after median sternotomy significantly impacts quality of life and is challenging to treat.
  • Current reconstructive options for complex chest wall deformities are limited.
  • A novel, single-stage surgical approach is needed for effective sternal reconstruction.

Purpose of the Study:

  • To present a multispecialty, single-stage technique for reconstructing an unstable thoracic cage using a donated sternum and ribs.
  • To evaluate the efficacy of incorporating adipose-derived stromal vascular fraction (ADSVF) cells and autologous muscle flaps in sternal reconstruction.
  • To demonstrate the feasibility of a complete sternal transplant for complex chest wall deformities.

Main Methods:

  • Utilized a donated sternum and ribs from a single donor, including adipose-derived stromal vascular fraction (ADSVF) cells and marrow.
  • Employed autologous muscle flaps stabilized with acellular dermal matrix to ensure vascular supply to grafts.
  • Used acellular dermal matrix for rib reconstruction and stabilization of stem cell and bone grafts.

Main Results:

  • Successfully reconstructed complex chest wall deformities in multiple patients through a one-stage operation.
  • Achieved the first reported successful complete sternal transplant.
  • Patients experienced a return to normal activities and an improved quality of life post-transplant.

Conclusions:

  • A multispecialty, single-stage sternal transplant using donor grafts, ADSVF cells, and muscle flaps is a viable treatment for severe chest wall deformities.
  • This technique offers a promising solution for sternal malunion or loss, significantly enhancing patient outcomes.
  • The successful application marks a significant advancement in thoracic reconstructive surgery and regenerative medicine.